Background:
Pregnancies complicated by pre-existing diabetes require early planning for optimal maternal and fetal outcomes. Evaluation of patient care is an essential driver for ongoing improvements.
Approach:
This is a retrospective audit of pregnancy preparation and subsequent outcomes comparing women with Type 1 (T1DM) against Type 2 (T2DM) Diabetes at Blacktown Hospital from 2023-2025. Statistical analysis of outcomes was undertaken in SPSS v30.
Outcomes:
219 pregnancies (40 T1DM, 179 T2DM) were included. Pre-pregnancy clinic attendance was low (1/40 vs 6/179) (p=1.000). Women with T2DM were older (34.5±5.4 vs 30.3±5 years; p<0.001) and had higher BMI (34.5±8.3 vs 28.5±8.5 kg/m²; p<0.001). Ethnicity differed significantly, with T1DM mostly European/White (45.0%), and T2DM more commonly South Asian (30.7%) or Oceanic Islander (21.8%) (p<0.001). Compared to T2DM, T1DM pregnancies had more macrosomia (30.0% vs 13.0%; p=0.008) and Special Care Nursery admissions (89.7% vs 52.3%; p<0.001). Pump therapy in T1DM was low (17.5%). High-dose folate was suboptimal in both T1DM (48.7%) and T2DM (37.0%) (p=0.174). Cardiac malformations occurred in 0/83 (0.0%) pregnancies with high dosage folate compared to 9/129 (7.0%) without use (p=0.013). Aspirin prescribing was incomplete (76.9% vs 65.5%; p=0.169) with pre-eclampsia rate 23.5% in this cohort, substantially higher than the Australian rate reported among women with pre-existing diabetes (5.0%).
Conclusion:
Missed opportunities were identified in pre-pregnancy care, preventative prescribing and diabetes technology. The strong association between high-dose folate use and fewer cardiac defects reinforces the need for pre-conception intervention, GP education and stronger referral pathways.