Comparing maternal and fetal pregnancy complications in women with pre-existing diabetes based on planning status: a retrospective audit. — ASN Events
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Comparing maternal and fetal pregnancy complications in women with pre-existing diabetes based on planning status: a retrospective audit. (#129)

Alia N Tun Ismail 1 2 , Hina Gul 3 , Srividhya Lakshmanaswami 4 , Kirsten Black 5 6 , Evelyn Hao 7 , Natassia Rodrigo 3 4 , Joy Cameron 4 , Hou Z Yong 4 , Emily Hibbert 3 4 5
  1. Campbelltown Hospital, Campbelltown, NSW, Australia
  2. Macarthur Diabetes Service, Campbelltown Hospital, Campbelltown, NSW, Australia
  3. Nepean Clinical School, Sydney Medical School, Faculty of Medicine and Health, the University of Sydney, Kingswood, NSW, Australia
  4. Endocrinology, Nepean Hospital, Kingswood, NSW, Australia
  5. Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW, Australia
  6. Charles Perkins Centre, the University of Sydney, Camperdown, NSW, Australia
  7. Endocrinology, Wollongong Hospital, Wollongong, NSW, Australia

Introduction

Pregnancies with pre-existing diabetes mellitus are associated with increased maternal and neonatal complications, particularly when peri-conception glycaemic control is suboptimal. Although preconception planning improves early glycaemia and pregnancy outcomes, engagement with pre-conception care remains low.

Aim

To describe pregnancy outcomes in women with pre-existing diabetes delivering at Nepean Blue Mountains Local Health District (NBMLHD) and examine associations between pregnancy planning, glycaemia and adverse outcomes.

Methods

We conducted a retrospective audit of electronic medical records for women with pre-existing diabetes delivering at NBMLHD between 2020–2025. Continuous variables are presented as mean ± SD or median (IQR), and categorical variables as number (percentage). Data collection is ongoing.

Results
Among 178 births in 150 women, 47% had type 1 diabetes (T1DM) and 53% had type 2 diabetes (T2DM). 60.1% of pregnancies were unplanned. Planning status was similar between T1DM and T2DM (50.7% vs 49.3%). Planned pregnancies were associated with earlier antenatal clinic engagement (median gestation at first antenatal visit 12.6 vs 14.0 weeks) and lower pre-pregnancy HbA1c (median 6.8% vs 7.6%) and first trimester HbA1c (median 6.8% vs 7.1%).

Among women with T1DM, 59% used closed-loop insulin pump therapy during pregnancy. Teratogenic medication exposure at first antenatal visit was more common in T2DM than T1DM (15% vs 7%) and similar between planned and unplanned pregnancies (12.7% vs 10.3%). Maternal complications occurred in 54.7% of planned pregnancies and 35.6% of unplanned pregnancies. Fetal complications were common across both groups (88.1% planned vs 75.2% unplanned), with perinatal mortality occurring in 8.6% and 3.8% respectively.

Conclusion
Unplanned pregnancy remains common among women with pre-existing diabetes and is associated with poorer peri-conception glycaemic control and delayed antenatal engagement. Despite better glycaemia in planned pregnancies, maternal and fetal complications were high across both planned and unplanned groups. Routine contraception counselling, preconception care, and pregnancy planning support are needed to improve outcomes.