Background & Aim
The Saint Vincent Declaration aimed to achieve pregnancy outcomes in diabetic women approximating non-diabetic women(1). This study evaluated preconception care, pregnancy management, and outcomes in women with type 2 diabetes mellitus (T2DM).
Method
A retrospective observational study of pregnancies at a tertiary obstetric hospital in Brisbane, Australia (January 2021–December 2024), comparing Southeast Asian, South Asian, Caucasian, Pacific Islander, African, and First Nations women.
Results
193 pregnancies in 169 women were analysed. Periconception HbA1c exceeded 6.5% in 123 pregnancies (64%), mean HbA1c 7.49% and BMI 33 kg/m². Mean gestation at first medical review was 13.2 weeks. Sixty-four women (33%) were managed with diet alone, and 14 (7.2%) with insulin. Exposure to GLP-1 receptor agonists, SGLT2 inhibitors, DPP-4 inhibitors, or sulphonylureas occurred in 70 pregnancies (36%). Asian women were more often treated with single oral agents, whereas other groups received more intensive regimens (p=0.010). Only 10 women (5.2%) received specialist diabetes care.
Pacific women had higher rates of nephropathy (p=0.017), and First Nations women had higher smoking rates (p<0.001). No significant associations were observed between ethnicity and PCOS, hypertension, MAFLD, or OSA.
Adverse outcomes included congenital malformations (11%), fetal/neonatal demise (7.8%), preterm birth (20%), LGA (31%), SGA (11%), and preeclampsia (9.4%). Pacific Islanders had poorer glycaemic control, later presentation, and worse outcomes. Ethnicity influenced fetal growth (p=0.002), but not delivery mode or major complications.
Conclusion
Suboptimal glycaemic control, late presentation, and use of medications with limited safety data suggest unplanned pregnancy and inadequate preconception counselling contribute to adverse outcomes in women with T2DM.