medwireNews: The integration of a comprehensive management plan into the framework for maternal care of the World Health Organization (WHO) has the potential to improve pregnancy outcomes for women with type 1 diabetes, according to the CARNATION study.
Jianping Weng (University of Science and Technology in China, Hefei) and co-authors explain that the WHO framework for maternal care “has been successfully implemented worldwide, including in China and many low and middle income countries”, as well as the CARNATION- The management plan was integrated into this existing infrastructure in 11 Chinese centers between 2015 and 2017.
The plan – consisting of a package insert for pregnant women with type 1 diabetes, a checklist for health care providers, and educational support for both groups – encompassed the prejudice about the postpartum period and included information on diet, managing diabetes and its complications, and monitoring blood pressure .
Among 133 pregnant women with type 1 diabetes who attended centers that implemented the management plan, 6.02% experienced the combined outcome of severe adverse pregnancy outcomes, defined as maternal or newborn death, congenital malformations, second trimester miscarriages, or stillbirths .
At 18.30%, this was lower than the rate of severe pregnancy outcomes in a control cohort of 153 women with type 1 diabetes who attended the same centers in 2012–2014 prior to the intervention. After adjusting for potential confounders, the management plan was associated with a 69% lower risk of serious adverse pregnancy outcomes.
The researchers also found that the management plan was associated with a 78% lower risk of serious adverse pregnancy outcomes when compared to a second control cohort of 116 pregnant women with type 1 diabetes who attended CARNATION centers 2015– were routinely treated in other centers in 2017 with rates of 6.02% versus 25.00%.
In addition, the management plan was associated with a significant reduction in the risk of miscarriages and stillbirths in the second trimester, as well as admission to the neonatal intensive care unit, when compared to any of the control groups.
These results “are evidence of a potentially clinically important impact of the comprehensive management plan on pregnancy outcomes in pregnant Chinese women who are pregnant [type 1 diabetes], ”Letter from Weng et al. In Diabetes Care.
“The management plan has made these improvements in a relatively resource constrained environment, which suggests that it is feasible, effective and worth developing [other] Countries covered by [the] WHO recommended maternal care framework, ”they add.
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Diabetes Care 2021; doi: 10.2337 / dc20-2692
