• Analysing socio-economic status of pregnant women not attending for screening for Diabetes in Pregnancy

      Owens, L; Carmody, L; Avalos, G (Irish Journal of Medical Science, 2010)
    • Atlantic Dip: a regional approach to the delivery of care results in improved pregnancy outcomes in women with pre-gestational diabetes mellitus.

      Avalos, G; Carmody, L; Dunne, F; Kirwin, B; Todd, M; Gallacher, Therese; Gaffney, G; Durkan, M; McHugh, C; 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 (2011)
      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.
    • Atlantic DIP: Diabetes in Pregnancy: a comparative study of stress and wellbeing in women with established diabetes, gestational diabetes, and those without diabetes

      Lydon, K; McGuire, B; Owens, LA; Sarma, K; Avalos, G; Carmody, L; O'Connor, C; Nestor, L; Dunne, F; Department of Medicine, National University of Ireland, Galway, Galway, Ireland, 2School of Psychology, National University of Ireland, Galway, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09-15)
      Background and aims: Diabetes in pregnancy increases the risk of maternal and perinatal morbidity and mortality. The experience of diabetes during pregnancy may be a significant source of stress, both because of the impact of the illness and associated treatments on the expectant mother and because of concern about the impact on the unborn child. In order to examine stress associated with diabetes during pregnancy, we carried out a prospective study in women with pre-existing (Type 1 or Type 2) Diabetes (PDM), Gestational Diabetes Mellitus (GDM), and non-diabetic pregnant controls (NDM). Materials and methods: The participants were 210 pregnant women - 25 with pre-existing diabetes (PDM), 77 with GDM and 108 healthy controls (NDM). All were attending antenatal services in six health care centres in Ireland. We measured stress and wellbeing with several standardised psychological questionnaires including The Pregnancy Experience Scale; The Depression Anxiety Stress Scale; the Multidimensional Perceived Social Support Scale; the Illness Perception Questionnaire-Diabetes; the Diabetes Self-Efficacy Scale; the SF-8 and the Problem Areas in Diabetes Scale. We hypothesized that diabetic women would report higher levels of stress than healthy controls and we also hypothesized that social support may confer a protective role. Results: We found a non-significant trend of increased stress and lower quality of life among diabetic women compared to non-diabetic controls. Women with PDM perceived their illness as having a higher impact on their lives than those with GDM (p<0.0001). However, women with pre-existing diabetes also reported significantly greater self-efficacy in relation to their diabetes management compared to their gestational diabetes counterparts (p<0.05). The results of the remaining questionnaires demonstrate a general trend towards higher distress in diabetic women compared to controls. The healthy controls reported higher perceived social support which may confer a protective role against psychological stress. Conclusion: These preliminary results suggest that pregnant diabetic women perceive themselves as having a lower quality of life and higher levels of stress in pregnancy, especially women with pre-existing diabetes. This may indicate a need for psychological support in these patients. However, further research is required.
    • The benefit of a pre-pregnancy care program in women with Type 1 and Type 2 diabetes: continued improvement

      Mustafa, E; Khalil, S; Kirwan, B; Carmody, L; Gallacher, T; Mitchell, Y; Todd, M; Hoashi, S; Durkan, M; Dunne, F; et al. (Royal Academy of Medicine in Ireland, 2011)
    • To establish trimester-specific reference ranges for glycated haemoglobin (HbA1c) in pregnancy

      O'Connor, CM; O'Shea, P; Owens, LA; Carmody, L; Avalos, G; Nestor, L; Lydon, K; Dunne, F; Department of Endocrinology, National University of Ireland, Galway, Ireland, 2Department of Clinical Biochemistry, University College Hospital, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09)
      Background and aims: Diabetes in Pregnancy imposes additional risks to both mother and infant. These poor outcomes are considered to be primarily related to glycaemic control which is monitored longitudinally through pregnancy by means of HbA1c. The correlation between HbA1c levels with clinical outcomes emphasises the need to measure HbA1c accurately, precisely and for data interpretation comparison to appropriately defined reference intervals. From July 1st 2010, the HbA1c assay in Irish laboratories became fully metrologically traceable to the IFCC standard, permitting HbA1c to be reported in IFCC units (mmol/mol) and derived DCCT/NGSP units (%) using the IFCC-DCCT/NGSP master equation (DCCT = Diabetes Control and Complications Trial, NGSP = National Glycohemoglobin standardisation program). The aim of this project is to establish trimester-specific reference ranges in pregnancy for IFCC standardised HbA1c in non-diabetic Caucasian women. This will allow us to define the goal for HbA1c during pregnancy complicated by diabetes. Materials and methods: Following informed consent blood was collected from 234 pregnant and 36 age -matched controls into EDTA and Fluoride oxalate tubes for HbA1c, haemoglobin and glucose measurement. Pregnancy trimester was defined as follows: T1 (up to 12 weeks), T2 (13 to 27 weeks), T3 (>28 weeks to term). The Menarini HA8160 automated haemoglobin (Hb) analyser was used to assay HbA1c. Results: Non-parametric analysis of the data was performed. The 95% IFCC HbA1c (DCCT) reference interval for Controls (n=59) 29-37mmol/mol (4.8-5.5%), Trimester 1 (n=27) 36mmol/mol (4.6-5.4%), Trimester 2 (n=107) 25-35mmol.mol (4.4-5.4%) and Trimester 3 (n=110) 28- 39 mmol/mol (4.7-5.7%). A statistically significant difference between the median HbA1c concentration of the control and Trimester 2 subjects, p <0.0001 was determined (Mann-Whitney test). Conclusion: As HbA1c changes throughout pregnancy, trimester-specific HbA1c reference intervals are required to manage diabetes in pregnancy appropriately.
    • Trimester-specific reference ranges for glycated haemoglobin in pregnancy

      O'Connor, C; O'Shea, P; Owens, L; Carmody, L; Avalos, G; Lydon, K; Nestor, L; Dunne, F; Department of Endocrinology, Galway University Hospitals, Galway 2Department of Clinical Biochemistry, Galway University Hospitals, Galway (Diabetic Pregnancy Study Group, 2011)
      Background and Aims: Diabetes in Pregnancy imposes additional risks to both mother and infant. These poor outcomes are considered to be primarily related to glycaemic control which is monitored longitudinally through pregnancy by means of HbA1c. The correlation between HbA1c levels with clinical outcomes emphasises the need to measure HbA1c accurately, precisely and for data interpretation comparison to appropriately defined reference intervals. From July 1st 2010, the HbA1c assay in Irish laboratories became fully metrologically traceable to the IFCC standard, permitting HbA1c to be reported in IFCC units (mmol/mol) and derived DCCT/NGSP units (%) using the IFCC-DCCT/NGSP master equation (DCCT = Diabetes Control and Complications Trial, NGSP = National Glycohemoglobin standardisation program). The aim of this project is to establish trimester-specific reference ranges in pregnancy for IFCC standardised HbA1c in non-diabetic Caucasian women. This will allow us to define the goal for HbA1c during pregnancy complicated by diabetes. Materials and methods: Following informed consent blood was collected from 234 pregnant and 36 age -matched controls into EDTA and Fluoride oxalate tubes for HbA1c, haemoglobin and glucose measurement. Pregnancy trimester was defined as follows: T1 (up to 12 weeks), T2 (13 to 27 weeks), T3 (>28 weeks to term). The Menarini HA8160 automated haemoglobin (Hb) analyser was used to assay HbA1c. Results: Non-parametric analysis of the data was performed. The 95% IFCC HbA1c (DCCT) reference interval for Controls (n=59) 29-37mmol/mol (4.8-5.5%), Trimester 1 (n=26) 36mmol/mol (4.6-5.4%), Trimester 2 (n=107) 25-35mmol.mol (4.4-5.4%) and Trimester 3 (n=107) 28- 39 mmol/mol (4.7-5.7%). A statistically significant difference between the median HbA1c concentration of the control and Trimester 2 subjects, p <0.0001 was determined (Mann-Whitney test). Conclusion: Trimester-specific HbA1c reference intervals are required to manage diabetes in pregnancy as HbA1c changes throughout pregnancy.