1429-P: A Review of Prepregnancy Care and Pregnancy Outcomes in Pregestational Diabetes—Are Prior Improvements in Pregnancy Preparation and Outcomes Maintained for Women with Pregestational Diabetes?

Women with pre-existing diabetes (T1DM/T2DM) face increased risk in pregnancy. Optimising glycaemic control, folic acid use and smoking cessation are all advised to improve outcomes. Maintaining these goals can be difficult. We retrospectively analysed data from sites across our Atlantic DIP network from 2015-17 and compared outcomes to data 2010-14 to see if prior improvements were maintained. Data was collected on pre-pregnancy care (PPC), glycaemic targets and neonatal outcomes. In total 98 women attended; 76 (78%)/22 (22%) with T1DM and T2DM respectively. Booking maternal BMI reduced but a fall in PPC attendance lead to lower folic acid use, greater teratogenic medication use and static smoking rates. Trimester 1 HbA1C was suboptimal in T1DM but patients subsequently reached target. HbA1C improved throughout pregnancy for T2DM and was at target (Table 1). Between the two time periods outcomes were unchanged for miscarriage, shoulder dystocia, NICU admission, macrosomia, LGA, SGA and birth weight. We recorded no stillbirths or congenital malformations. Improvements occurred in prematurity (