Endocrine Abstracts

Pregnancy outcomes in pre-gestational diabetes mellitus are suboptimal. Identified modifiable risk factors include pre-pregnancy care (PPC) and optimisation of glycaemic control prior to conception. This is a retrospective review of pregnancy preparedness, pregnancy care and outcomes relating to type 2 diabetes (T2D). In total 321 pregnancies from 15 hospitals were included. In the T2DM group (n = 153), mean maternal age was 34.9 years, BMI 34.3kg/m² and ethnicity largely white (40%). Diabetes was present for 4 years before pregnancy. 12 (7.8%) attended pre-pregnancy clinic. Pre-pregnancy HbA1c was 56mmol/mol (n = 44). Following conception, 11 (7.2%) women discontinued oral hypoglycaemic agents contraindicated in pregnancy (4 GLP1RA, 5 SGLT2i, 2 DPP4i). 54 (35%) took folic acid. The majority received insulin & metformin (68 women, 44%), insulin alone (42, 28%) and metformin alone (13, 8.5%). Mean HbA1c was 51 mmol/mol in the first trimester and 41 mmol/mol in the third trimester. A minority had access to sensor therapy (18 continuous, 5 flash). 51 women (33%) were hospitalised during pregnancy, 7 (4.6%) had hypertension and 1 (0.1%) experienced pre-eclampsia. Live birth rate was 73%. 80 women (71%) underwent Caesarean section, 28 (25%) had spontaneous delivery and 4 (3.6%) assisted delivery. Mean birthweight was 3224 g at gestation 37+3 weeks. 19 (17.6%) were large for gestational age and 8 (7.4%) were small. 3 cases of congenital anomaly occurred. 25 neonates were admitted to SCBU. Rates of PPC were low. Consequently, glycemic control in early pregnancy was above target. Ongoing effort to modify risk and improve outcomes is needed.