Atlantic Dip: a regional approach to the delivery of care results in improved pregnancy outcomes in women with pre-gestational diabetes mellitus.

Hdl Handle:
http://hdl.handle.net/10147/238810
Title:
Atlantic Dip: a regional approach to the delivery of care results in improved pregnancy outcomes in women with pre-gestational diabetes mellitus.
Authors:
Avalos, G; Carmody, L; Dunne, F; Kirwin, B; Todd, M; Gallacher, Therese; Gaffney, G; Durkan, M; McHugh, C
Is Part Of:
43rd Annual Meeting of DPSG Cambridge 2011
Affiliation:
1. Department of Diabetes, Galway University Hospital, National University of Ireland, Galway, Ireland 2. Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
Issue Date:
2011
URI:
http://hdl.handle.net/10147/238810
Abstract:
Background and aims: The Atlantic Diabetes in Pregnancy (DIP) group established in 2005 represents 5 antenatal centres in a wide geographical location. The group provides care for women with diabetes before during and after pregnancy. We examined the outcomes of pregnancy in 2 periods (2005-2007) and (2008-2010) before and after the implementation of a region wide approach to delivery of care. The process of care changed from stand alone clinics with different personnel to integrated pre-pregnancy (PPC) and combined diabetes antenatal clinics in a hub and spoke fashion supported by an electronic data collection system, clinical care guidelines, professional education and patient education materials. Materials and Methods: Maternal (Glycated Haemoglobin (HbA1C), attendance at PPC, uptake of folic acid, Caesarean Section (CS) rates) and fetal/neonatal (miscarriage, stillbirth and perinatal mortality, admission to neonatal unit and birth weight >4kg) outcomes were recorded. Results: 104 and 152 pregnancies (23% and 30% Type 2) occurred in periods 1 and 2 respectively. Attendance for PPC increased from 28% to 53%, uptake of folic acid from 43% to 57%, and % of women with glycated haemoglobin at booking <7% increased from 51% to 60% between the 2 periods. In addition HbA1C decreased across all trimesters for women with both type 1 and type 2 diabetes over time. Elective CS rate increased from 18% to 41% with no change in the emergency CS rate. The take home baby rate increased from 76% to 89% and miscarriage/deaths<24 weeks decreased from 22% to 11%. The stillbirth and perinatal mortality rates both decreased from 25 to 15/1000, admission to neonatal unit decreased from 63% to 57% and % of babies >4kg decreased from 32% to 24%. Conclusion: A regional approach to the delivery of care has resulted in better pregnancy preparation for the mother and better neonatal outcomes as a consequence, resulting in a higher take home baby rate. The higher elective CS rate needs to be addressed.
Item Type:
Conference Poster
Language:
en
Keywords:
PREGNANCY; HEALTH SERVICES AND THEIR MANAGEMENT

Full metadata record

DC FieldValue Language
dc.contributor.authorAvalos, Gen_GB
dc.contributor.authorCarmody, Len_GB
dc.contributor.authorDunne, Fen_GB
dc.contributor.authorKirwin, Ben_GB
dc.contributor.authorTodd, Men_GB
dc.contributor.authorGallacher, Thereseen_GB
dc.contributor.authorGaffney, Gen_GB
dc.contributor.authorDurkan, Men_GB
dc.contributor.authorMcHugh, Cen_GB
dc.date.accessioned2012-08-15T14:52:34Z-
dc.date.available2012-08-15T14:52:34Z-
dc.date.issued2011-
dc.identifier.urihttp://hdl.handle.net/10147/238810-
dc.description.abstractBackground and aims: The Atlantic Diabetes in Pregnancy (DIP) group established in 2005 represents 5 antenatal centres in a wide geographical location. The group provides care for women with diabetes before during and after pregnancy. We examined the outcomes of pregnancy in 2 periods (2005-2007) and (2008-2010) before and after the implementation of a region wide approach to delivery of care. The process of care changed from stand alone clinics with different personnel to integrated pre-pregnancy (PPC) and combined diabetes antenatal clinics in a hub and spoke fashion supported by an electronic data collection system, clinical care guidelines, professional education and patient education materials. Materials and Methods: Maternal (Glycated Haemoglobin (HbA1C), attendance at PPC, uptake of folic acid, Caesarean Section (CS) rates) and fetal/neonatal (miscarriage, stillbirth and perinatal mortality, admission to neonatal unit and birth weight >4kg) outcomes were recorded. Results: 104 and 152 pregnancies (23% and 30% Type 2) occurred in periods 1 and 2 respectively. Attendance for PPC increased from 28% to 53%, uptake of folic acid from 43% to 57%, and % of women with glycated haemoglobin at booking <7% increased from 51% to 60% between the 2 periods. In addition HbA1C decreased across all trimesters for women with both type 1 and type 2 diabetes over time. Elective CS rate increased from 18% to 41% with no change in the emergency CS rate. The take home baby rate increased from 76% to 89% and miscarriage/deaths<24 weeks decreased from 22% to 11%. The stillbirth and perinatal mortality rates both decreased from 25 to 15/1000, admission to neonatal unit decreased from 63% to 57% and % of babies >4kg decreased from 32% to 24%. Conclusion: A regional approach to the delivery of care has resulted in better pregnancy preparation for the mother and better neonatal outcomes as a consequence, resulting in a higher take home baby rate. The higher elective CS rate needs to be addressed.en_GB
dc.language.isoenen
dc.relation.ispartof43rd Annual Meeting of DPSG Cambridge 2011en_GB
dc.subjectPREGNANCYen_GB
dc.subjectHEALTH SERVICES AND THEIR MANAGEMENTen_GB
dc.titleAtlantic Dip: a regional approach to the delivery of care results in improved pregnancy outcomes in women with pre-gestational diabetes mellitus.en_GB
dc.typeConference Posteren
dc.contributor.department1. Department of Diabetes, Galway University Hospital, National University of Ireland, Galway, Ireland 2. Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Irelanden_GB
dc.description.provinceConnachten
All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.