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Preconception care for diabetic women for improving maternal and fetal outcomes : a systematic review and meta-analysis
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Wahabi, Haifa A. A., Alzeidan, Rasmieh A., Bawazeer, Ghada A., Alansari, Lubna A. and Esmaeil, Samia A. (2010) Preconception care for diabetic women for improving maternal and fetal outcomes : a systematic review and meta-analysis. BMC Pregnancy and Childbirth, Volume 10 (Number 1). Article number 63. doi:10.1186/1471-2393-10-63
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Official URL: http://dx.doi.org/10.1186/1471-2393-10-63
Abstract
Background
Preexisting diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. Despite improvement in the access and quality of antenatal care recent population based studies demonstrating increased congenital abnormalities and perinatal mortality in diabetic mothers as compared to the background population. This systematic review was carried out to evaluate the effectiveness and safety of preconception care in improving maternal and fetal outcomes for women with preexisting diabetes mellitus.
Methods
We searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINAHL up to December 2009, without language restriction, for any preconception care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women of reproductive age group with type I or type II diabetes. Study design were trials (randomized and non-randomized), cohort and case-control studies. Of the 1612 title scanned 44 full papers were retrieved of those 24 were included in this review. Twelve cohort studies at low and medium risk of bias, with 2502 women, were included in the meta-analysis.
Results
Meta-analysis suggested that preconception care is effective in reducing congenital malformation, RR 0.25 (95% CI 0.15-0.42), NNT17 (95% CI 14-24), preterm delivery, RR 0.70 (95% CI 0.55-0.90), NNT = 8 (95% CI 5-23) and perinatal mortality RR 0.35 (95% CI 0.15-0.82), NNT = 32 (95% CI 19-109). Preconception care lowers HbA1c in the first trimester of pregnancy by an average of 2.43% (95% CI 2.27-2.58). Women who received preconception care booked earlier for antenatal care by an average of 1.32 weeks (95% CI 1.23-1.40).
Conclusion
Preconception care is effective in reducing diabetes related congenital malformations, preterm delivery and maternal hyperglycemia in the first trimester of pregnancy.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RG Gynecology and obstetrics | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School | ||||||||
| Library of Congress Subject Headings (LCSH): | Pregnancy -- Complications, Diabetes, Preconception care | ||||||||
| Journal or Publication Title: | BMC Pregnancy and Childbirth | ||||||||
| Publisher: | BioMed Central Ltd. | ||||||||
| ISSN: | 1471-2393 | ||||||||
| Official Date: | 14 October 2010 | ||||||||
| Dates: |
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| Volume: | Volume 10 | ||||||||
| Number: | Number 1 | ||||||||
| Article Number: | Article number 63 | ||||||||
| DOI: | 10.1186/1471-2393-10-63 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access |
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