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To determine if prenatal care affects adverse perinatal outcomes in pregnant women with Type-2 Diabetes Mellitus.
This was a retrospective cohort study of women with diabetes mellitus who carried pregnancies to term in the state of California between 1997 and 2006, using vital statistics data linked to birth certificates. Women were stratified by time of presentation to care and we compared those who presented in the first trimester to those who presented in the 9th month of gestation. Perinatal outcomes looked at included: preeclampsia, macrosomia, preterm delivery, cesarean delivery and intrauterine fetal demise (IUFD). The two groups were compared with chi-squared testing to determine statistically significance.
In those women with T2DM who did not present to prenatal care until their 9th month of gestation, there was an increased rate of IUFD. Women who presented in the 9th trimester had a 16% risk of IUFD compared to 1% in those who presented in the 1st trimester. There was also an increased rate of preterm birth in the late presentation cohort (29.44% in the 9th month vs 21.02% in the 1st trimester). There was no difference in rates of macrosomia or preeclampsia between the two cohorts (Table).
Identification of T2DM and earlier presentation to prenatal care is associated with improved maternal and fetal outcomes.