Pregnancy Planning, Preconception Care and Early Glycaemic Control in Women with Pre-existing Diabetes.  — ASN Events
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  3. Pregnancy Planning, Preconception Care and Early Glycaemic Control in Women with Pre-existing Diabetes. 

Pregnancy Planning, Preconception Care and Early Glycaemic Control in Women with Pre-existing Diabetes.  (#102)

Kate Cheney 1 , Glynis P Ross 1 2 , Ariane Sweeting 1 2 , Jane Tooher 2 , Edwina Dorney 1 2 , Kirsten Black 1 2
  1. The University of Sydney, Sydney, NSW, Australia
  2. NSW Health , Sydney Local Health District, Sydney, NSW, Australia

Background and Aim: 

Pre‑existing diabetes in pregnancy (PEDM), including type 1 and type 2 diabetes mellitus, is associated with increased risks of congenital malformations and adverse perinatal outcomes. Many risks can be reduced through pregnancy planning and engagement with preconception care, particularly optimisation of glycaemic control prior to conception. Despite this, unplanned pregnancy and suboptimal uptake of preconception care remain common. This study aimed to describe pregnancy planning behaviours among women with PEDM attending public maternity services and examine associations with early pregnancy glycaemic control. 

Methods: 
A retrospective cohort study was conducted of women with PEDM attending maternity care at two public hospitals in the Sydney Local Health District between December 2019 and October 2024. Data were extracted from the electronic maternity record following ethics approval with a waiver of consent. Variables included sociodemographic characteristics, documentation of preconception care, and HbA1c values prior to conception and in pregnancy. Primary outcomes were pregnancy planning behaviours and achievement of target glycaemic control (HbA1c <6.5%). 

Results: 
A total of 213 women with PEDM attended for maternity care. HbA1c data were available for 199 women, of whom 47% (93/199) achieved an HbA1c ≤6.5% at the first recorded measure. Pregnancy planning status was available for 198 women, with 66% (130/198) reporting a planned pregnancy. Women with Type 1 Diabetes were more likely to have a planned pregnancy than women with Type 2 Diabetes (56.2% vs 43.8%; p<0.05). Fewer than one‑third had a documented preconception HbA1c, with similar rates among planned and unplanned pregnancies. Women with planned pregnancies were significantly more likely to achieve target HbA1c compared with those with unplanned pregnancies (59.2% vs 23.2%; p<0.001), with lower mean HbA1c (6.58% vs 8.11%).  

Conclusions: 
Pregnancy planning was strongly associated with improved early pregnancy glycaemic control, highlighting missed opportunities for preconception HbA1c optimisation and the need to embed preconception care within routine diabetes management. Given the lower rates of pregnancy planning among women with type 2 diabetes, targeted strategies to increase preconception care are especially needed in this population.