The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Development of the Audit Tool
2.3. Data Collection
2.4. Feedback Reports
2.5. Statistical Analysis
3. Results
3.1. Maternal Characteristics
3.2. Gestational Diabetes Mellitus
3.3. Pre-Gestational Diabetes
3.3.1. Pre-Gestational Diabetes: Pregnancy Planning
3.3.2. Pre-Gestational Diabetes: Antenatal Management
3.3.3. Pre-Gestational Diabetes: Pregnancy Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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No | Best Practice Recommendations for Women with Diabetes |
---|---|
1 | All pregnancies should be intended pregnancies. |
2 | Pre-pregnancy counselling regarding risks should be provided. |
3 | Teratogenic medications should be avoided before conception and during pregnancy. |
4 | Blood glucose should be near normal before conception and during pregnancy. |
5 | Women should receive high dose (2.5–5 mg daily) folate supplementation starting 3 months prior to conception until 12 weeks gestation. |
6 | Oral hypoglycaemic agents should be reviewed prior to conception. |
7 | First antenatal visit should occur early in pregnancy, before 8 weeks of gestation. |
8 | Glycaemic control should be balanced against the risk of hypoglycaemia in early pregnancy. |
9 | Women with diabetes should be monitored for signs or progression of diabetes microvascular complications. |
10 | Vaginal birth should be encouraged unless there are obstetric or fetal indications for caesarean section. |
11 | Breastfeeding should be encouraged for all women with diabetes. |
Category | Data Items |
---|---|
For all women | Patient ID, date of birth, date of referral, EDC, estimated EDC by ultrasound, ethnic group, gestation at first review, gravidity, parity, height, pre-pregnancy weight, booking weight, smoking status, chronic hypertension, gestational hypertension, preeclampsia, delivery method, baby’s date of birth, gestational age at delivery, baby sex, birth weight, APGAR at 5 mins, shoulder dystocia, other birth trauma, admission to SCN/NICU, neonatal hypoglycaemia <2.6 mmol/L, jaundice needing phototherapy, minor congenital malformation, major congenital malformation, breast feeding on discharge. |
Women with GDM | OGTT fasting, OGTT 1 h, OGTT 2 h, HbA1c at GDM diagnosis, GDM treatment. |
Women with type 1 or type 2 diabetes | Planned pregnancy, OHA at conception, statin at conception, ACE/ARB at conception, folate (1st trimester folate dose), aspirin use, retinopathy, nephropathy, hypoglycaemia needing assistance, number of hypoglycaemic episodes needing assistance, eGFR, urine ACR, HbA1c % trimester 1, HbA1c % trimester 2, HbA1c % trimester 3, type 1 diabetes treatment, type 2 diabetes treatment. |
Characteristics | N | Mean ± SD or n (%) (Range) @ | Range (N, Mean or % Across All Sites) | Number of Sites Missing 100% Data (Sites Not Reporting/Collecting) † | Missing Values | |
---|---|---|---|---|---|---|
N | % Missing Range Across All Sites | |||||
Number of women | 10,144 | -- | 59–2426 | 0 | -- | -- |
GDM | 8696 | -- | 54–2397 | 0 | -- | -- |
Type 1 diabetes | 435 | -- | 7–295 | 0 | -- | -- |
Type 2 diabetes | 1013 | -- | 19–428 | 0 | -- | -- |
Age (years) | 10,114 | 32.3 ± 5.5 (15–51) | 31.0–35.1 | 0 | 30 | 0–11.9 |
Gravidity | 10,065 | 2.9 ± 1.9 (1–22) | 2.4–3.3 | 0 | 79 | 0–8.9 |
Parity | 10,066 | 1.3 ± 1.4 (0–11) | 0.8–1.6 | 0 | 78 | 0–16.9 |
Pre-pregnancy weight (kg) | 6471 | 74.7 ± 21.1 (34.0–185.0) | 68.5–89.8 | 3 | 3673 | 0–100 |
Mean Pre-pregnancy BMI (kg/m2) | ||||||
GDM | 6060 | 28.1 ± 7.0 (26.2–32.7) | 26.2–32.7 | 5 | 2636 | 30.3 |
Type 1 diabetes | 215 | 26.0 ± 5.4 (22.8–30.7) | 22.8–30.7 | 5 | 320 | 73.6 |
Type 2 diabetes | 244 | 31.5 ± 7.1 (29.9–38.6) | 29.1–38.6 | 4 | 769 | 75.9 |
Booking weight (kg) | 6191 | 84.0 ± 23.5 (33.9–193.0) | 71.3–88.6 | 4 | 3953 | 0–99.9 |
History of hypertension | 296 | 6.7 | 1.9–12.9 | 2 | 5739 | 0–100 |
Smoking | 566 | 9.1 | 2.3–15.1 | 2 | 3919 | 0–100 |
Variables | Mean ± SD or N/Total Available Data (%)@ | Range Across Sites | Number of Sites Missing 100% Data | Missing Across Sites Reporting N/(%) † |
---|---|---|---|---|
Gestation at first review (weeks) | 24.8 ± 7.2 | 22.1–26.7 *** | 4 | 6195 (71.2) |
Diet Only | 2082/5278 (39.4) | 28.8–57.3 ** | 1 | 3418 (39.3) |
Metformin use only | 991/5278 (18.8) | 0.4–43.7 ** | 1 | 3418 (39.3) |
Insulin use only | 1671/5278 (31.7) | 4.1–95.6 ** | 1 | 3418 (39.3) |
Cesarean delivery:
| 1030 (12.1) 707 (9.5) 1771 (20.3) | 3.6–23.7 *** 3.5–21.2 *** 12.3–42.6 *** | 2 2 0 | 195 (2.2) 1225 (14.1) 0 |
Gestational age at delivery (weeks) | 38.6 ± 1.5 | 38.2–38.9 *** | 0 | 174 (2.0) |
Late preterm (34–37 weeks) | 651/8696 (7.5) | 3.7–9.4 * | 0 | 174 (2.0) |
Very preterm/moderately preterm (<34 weeks) | 128/8696 (1.5) | 0.2–2.2 * | 0 | 174 (2.0) |
Birth weight ≥4.0 kg ≤2.5 kg | 819/8526 (9.6) 509/8526 (6.0) | 5.9–13.9 *** 1.9–6.8 # | 0 0 | 170 (2.0) 170 (2.0) |
LGA | 754/5759 (13.1) | 10.3–26.7 *** | 2 | 2937 (33.8) |
SGA | 538/5759 (9.3) | 0–11.9 *** | 2 | 2937 (33.8) |
Preeclampsia | 110/3590 (3.1) | 2.0–5.2 *** | 2 | 5106 (58.7) |
Shoulder dystocia | 92/3321 (2.8) | 0.0–7.2 *** | 4 | 4629 (53.2) |
Admission to SCN/NICU | 710/3347 (21.2) | 16.7–25.0 *** | 3 | 5378 (61.8) |
Neonatal hypoglycaemia <2.6 mmol/L | 690/4079 (16.9) | 6.0–27.0 *** | 3 | 4599 (52.9) |
Jaundice needing phototherapy | 122/3261 (4.9) | 4.7–5.3 # | 5 | 5435 (62.5) |
Minor congenital malformations Major congenital malformations | 22/3321 (0.7) 61/3321 (1.8) | 0.0–1.2 # 0.9–3.4 ** | 4 4 | 4616 (53.1) 4629 (53.2) |
Breast feeding on discharge | 795/1273(62.5) | 57.4–62.7 # | 6 | 7279 (83.7) |
Variables | Type 1 Diabetes N = 435 | Type 2 Diabetes N = 1013 | ||||||
---|---|---|---|---|---|---|---|---|
N/(%) Mean ± SD or %@ | Range Across Sites | Number of Sites Missing 100% Data | Missing Values Across Sites Reporting N/(%) † | N/(%) Mean ± SD or %@ | Range | Number of Sites Missing 100% Data | Missing Values Across Sites Reporting N/(%) † | |
Gestation at first review (weeks) | 9.1 ± 5.3 | 3–27 *** | 4 | 343 (78.9) | 11.1 ± 6.1 | 3.5–33 * | 5 | 862 (85.1) |
Pregnancy planning | 65/101 (64.4) | 14.3–87.5 *** | 3 | 339 (77.9) | 97/207 (46.9) | 20.0–63.2 * | 4 | 812 (80.2) |
OHA/GLP1RA on conception | 1/94 (1.1) | -- | 4 | 342 (78.6) | 100/210 (47.6) | 20.0–58.2 ** | 5 | 824 (81.3) |
Statin at conception | 0/93 (0.0) | -- | 4 | 342 (78.6) | 1/152 (0.7) | -- | 5 | 862 (85.1) |
ACEI/ARB at conception | 1/93 (1.1) | -- | 4 | 342 (78.6) | 1/152 (0.7) | -- | 5 | 863 (85.2) |
First trimester Folate (5mg) | 92/101 (91.1) | 28.6–100 *** | 3 | 335 (77.0) | 178/207 (86.0) | 57.9–100 *** | 4 | 810 (80.0) |
Retinopathy | 77/428 (18.0) | 6.3–39.6 ** | 1 | 49 (11.3) | 16/673 (2.4) | 0.7–7.9 * | 2 | 439 (43.3) |
Nephropathy | 21/428 (4.9) | 3.2–6.3 # | 1 | 40 (9.2) | 95/991 (9.6) | 5.3–20.0 *** | 1 | 97 (9.6) |
Urine ACR | 145 (33.3) | 26.4–86.8 # | 290 (66.7) | 196 (19.3) # | 9.3–94.7 | 817 (80.7) | ||
Aspirin use in pregnancy | 215/428 (50.2) | (13.2–59.0) *** | 1 | 343 (78.9) | 178/673 (26.4) | (0–55.6) *** | 2 | 862 (85.1) |
Hypoglycaemia needing assistance | 0/45 (0.0) | -- | 6 | 390 (89.7) | 1/24 (4.2) | -- | 7 | 989 (97.6) |
HbA1c 1st trimester | 7.7 ± 1.6 | 5–16.5 ** | 2 | 46 (10.6) | 7.3 ± 1.7 | 4.2–14.0 * | 3 | 468 (46.2) |
HbA1c 2nd trimester | 6.6 ± 1.1 | 4.5–11.1 ** | 1 | 321 (73.8) | 6.1 ± 1.1 | 4.3–10.4 * | 2 | 821 (81.0) |
HbA1c 3rd trimester | 6.8 ± 1.0 | 4.8–11.0 * | 1 | 44 (10.1) | 6.3 ± 1.1 | 4.0–12.6 ** | 2 | 411 (40.6) |
HbA1c 1st trimester >6.5% (48mmol/mol) | 78.4 | 59.6–100 * | 2 | 46 (10.6) | 54.6 | 0–58.3 ** | 3 | 469 (46.3) |
HbA1c 2nd trimester >6.0% (42 mmol/mol) | 69.9 | 50.0–82.4 # | 1 | 322 (74.0) | 41.7 | 5.9–62.5 # | 2 | 821 (81.0) |
HbA1c 3rd trimester >6.0% (42 mmol/mol) | 77.2 | 50.0–88.6 # | 1 | 45 (10.3) | 48.5 | 12.5–100 * | 2 | 411 (40.6 |
Diet Only | -- | -- | -- | -- | 3/568 (0.5) | 0–0.5 | 1 | 445 (43.9) |
Metformin use only | -- | -- | -- | -- | 158/568 (27.8) | 0–100 | 1 | 445 (43.9) |
Insulin use only | -- | -- | -- | -- | 132/568 (23.2) | 0–100 | 1 | 445 (43.9) |
Metformin and Insulin use | -- | -- | -- | -- | 275/568 (48.4) | 0–79.9 | 1 | 445 (43.9) |
Insulin pump | 49/134 (36.6) | 0–68.8 | 1 | 301 (69.2) | -- | -- | - | -- |
Cesarean delivery: (a) Elective (b) Emergency | 50/137 (36.5) 36/87 (41.4) | 12.5–45.8 # 17.4–57.7 ** | 1 1 | 298 (68.5) 348 (80.0) | 97/574 (16.9) 49/477 (10.3) | 0–73.7 *** 0–48.3 *** | 1 1 | 439 (43.3) 536 (52.9) |
Gestational age at delivery (weeks) | 36.4 ± 1.7 | 28.1–40.2* | 0 | 1 (0.2) | 37.3 ± 1.8 | 27.3–41.3 *** | 0 | 12 (1.2) |
Late preterm (34–37 weeks) | 208/435 (47.9) | 7.5–52.1 * | 0 | 1 (0.2) | 227/1013 (22.4) | 13.6–31.6 * | 0 | 12 (1.2) |
Very preterm/moderately preterm ( < 34 weeks) | 36/435 (8.3) | 0.5–28.6 # | 0 | 1 (0.2) | 58/1013 (5.7) | 4.5–7.3 # | 0 | 12 (1.2) |
Birth weight ≥ 4.0 kg ≤ 2.5 kg | 103/432 (23.8) 37/432 (8.6) | 14.3–37.5 # 2.1–14.3 # | 0 0 | 3 (0.7) 3 (0.7) | 157/1003 (15.7) 101/1003 (10.1) | 0–23.6 ** 5.3–15.8 # | 0 0 | 10 (1.0) 10 (1.0) |
LGA | 70/112 (62.5) | 20.0–85.7 # | 1 | 323 (74.3) | 58/225 (25.8) | 15.8–33.3 # | 2 | 788 (77.8) |
SGA | 5/112 (4.5) | 0–16.7 # | 1 | 323 (74.3) | 29/225 (12.9) | 0–20.0 # | 2 | 788 (77.8) |
Preeclampsia | 76/425 (17.9) | 14.9–28.6# | 0 | 10 (2.3) | 74/681 (10.9) | 5.0–33.3* | 1 | 332 (32.8) |
Shoulder dystocia | 2/102 (2.0) | 0–3.1 # | 2 | 336 (77.2) | 1/158 (0.6) | - | 3 | 860 (84.9) |
Admission to SCN/NICU | 279/428 (65.2) | 12.5–100 *** | 1 | 14 (3.2) | 273/676 (40.4) | 21.8–50.0 * | 2 | 362 (35.7) |
Neonatal hypoglycaemia <2.6 mmol/L | 232/435 (53.3) | 12.5–87.5 *** | 0 | 24 (5.5) | 227/695 (32.7) | 10.5–52.6 ** | 1 | 390 (38.5) |
Jaundice needing phototherapy | 44/140 (31.4) | 12.5–51.3 ** | 1 | 301 (69.2) | 54/267 (20.2) | 5.3–40.0 # | 2 | 770 (76.0) |
Minor congenital malformations Major congenital malformations | 5/94 (5.3) 3/94 (3.2) | 6.0–28.6 * 2.1–16.7 # | 3 3 | 344 (79.1) 343 (78.9) | 9/103 (8.7) 2/103 (1.9) | 0–15.8 # 0–5.3 # | 4 4 | 918 (90.6) 918 (90.6) |
Breast feeding on discharge | 98/125(78.4) | 57.1–93.8 * | 3 | 313 (72.0) | 141/190 (74.2) | 20.0–89.5 * | 4 | 831 (82.0) |
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Immanuel, J.; Flack, J.; Wong, V.W.; Yuen, L.; Eagleton, C.; Graham, D.; Lagstrom, J.; Wolmarans, L.; Martin, M.; Cheung, N.W.; et al. The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme. Int. J. Environ. Res. Public Health 2021, 18, 4899. https://doi.org/10.3390/ijerph18094899
Immanuel J, Flack J, Wong VW, Yuen L, Eagleton C, Graham D, Lagstrom J, Wolmarans L, Martin M, Cheung NW, et al. The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme. International Journal of Environmental Research and Public Health. 2021; 18(9):4899. https://doi.org/10.3390/ijerph18094899
Chicago/Turabian StyleImmanuel, Jincy, Jeff Flack, Vincent W Wong, Lili Yuen, Carl Eagleton, Dorothy Graham, Janet Lagstrom, Louise Wolmarans, Michele Martin, Ngai Wah Cheung, and et al. 2021. "The ADIPS Pilot National Diabetes in Pregnancy Benchmarking Programme" International Journal of Environmental Research and Public Health 18, no. 9: 4899. https://doi.org/10.3390/ijerph18094899