BACKGROUND: It is well recognised that pregnancies complicated by pre-gestational diabetes mellitus (PGDM) are high risk compared to the general antenatal population and even pregnancies impacted by gestational diabetes. Logically, a key area of optimisation is in the pre-conception space, however there is paucity of evidence comparing the influence of pre-conception counselling (PCC) on pregnancy consequences. In this retrospective audit, we aim to evaluate whether PCC conferred improved pregnancy outcomes in patients with PGDM who underwent their antenatal care at the Townsville University Hospital (TUH).
METHODS: The electronic medical records of all pregnancies with PGDM were screened from the period 2015-2024 to identify the rate of PCC and incidence of key maternal and neonatal adverse outcomes.
RESULTS: Out of 117 pregnancies, only 41 (35.0%) had underwent pre-conception counselling. Of this, 29 (70.7%) had T1DM. For maternal complications, pre-eclampsia and surgical delivery appeared higher in the counselled group. Pre-term delivery was lower. For neonatal outcomes, incidence of neonatal hypoglycaemia appeared higher in those who received counselling whilst admission to special/intensive care nursery was reduced. These differences were not statistically significant.
CONCLUSIONS: This Audit reinforced that the burden of PGDM is high at TUH, and pregnancies complicated by PGDM are associated with elevated incidence of adverse outcomes. It would be prudent not to dismiss PCC as a vital intervention. In fact, intensification of the PCC intervention could be key in improving complications and this should be achieved by increasing the quality, improving the timing and enhancing the reach of PCC.