Mulla BM and Zelig CM
Aims/hypothesis: Poor glycemic control at conception, a strong risk factor for birth defects, is frequently
attributed to low rates of pre-conceptual counseling. The objective of this study was to determine if counseling during a first pregnancy with diabetes improved glycemic control at conception in subsequent pregnancies.
Methods: Case controlled. 71 diabetic women previously followed during pregnancy at a single tertiary center were divided into two groups, those with diabetes at the start of a previous pregnancy, and those without. The two groups were compared for glycemic control at conception; hemoglobin A1C ≥ 7 was considered poor control. The two groups were also compared for very poor control (hemoglobin A1C ≥ 9), pre-conceptual counseling, and preconceptual folic acid use.
Results: Poor glycemic control at conception was as prevalent in the 29 previous diabetic patients as in the 42 first-time diabetic patients (51.7% vs. 57.1%, p=0.7). There was no difference in the proportion of diabetic patients with very poor control (17.2% vs. 23.8%, p=0.5), pre-conceptual counseling (6.9% vs. 4.8%, p=1.0) and folic acid use (32.1% vs. 31.0%, p=0.9).
Conclusions/interpretation: Previous pregnancy affected by diabetes did not improve glycemic control in a subsequent pregnancy. Expanding the counseling these patients receive in our institution should be considered.