Background: Preconception planning for pregnancy in T1D is the ideal to minimise impact of diabetes on baby and mother. Adolescent pregnancies have higher risks even without diabetes Pregnancy planning in young women with T1D is uncommon and this behaviour has the potential to adversely impact pregnancy outcomes.
Aim: Retrospective review of all pregnancies managed in the Diabetes Transition Clinic at Westmead Hospital between January 2009 and December 2014 to determine if there is a difference in outcomes depending on age at first conception.
Methods: Retrospective chart review to determine age at transition, age at conception, use of contraception, use of preconception high dose folate (5mg), HbA1c at conception, HbA1c at delivery, best HbA1c achieved in pregnancy, birth outcome and birth weight of baby.
Results: There were 18 first pregnancies over the study period, mean age at conception 22 yrs (17-25). Mean age at transition was 17.6±1.5 years. Mean HbA1c at transition was 9.6±1.9% and mean HbA1c at conception 8.9±2.0% (NS). There was a significant negative correlation between age and HbA1c at conception (p<0.01). The lowest HbA1c was achieved at a mean of 15.8 weeks gestation (7.2±1.4%) and was significantly lower than at conception, P<0.01. Comparison of outcomes in those <20 cf >20 years at conception is summarised in the table.
|
Age at conception |
<20 |
>20 |
P value |
|
n |
8 |
10 |
|
|
Folate at conception |
2 |
5 |
NS |
|
Age transition |
17.5±0.7 |
17.6±2.0 |
NS |
|
HbA1c at transition % |
9.5±1.2 |
9.8±2.3 |
NS |
|
HbA1c conception % |
10.3±1.5 |
7.9±1.7 |
<0.01 |
|
Lowest HbA1c pregnancy |
8.0±1.3 |
6.7±1.2 |
<0.05 |
|
Major congenital defects |
2 |
0 |
NS |
Conclusion. Delaying age of conception to >20yrs is critical to achieving lower HbA1c at conception and improving pregnancy outcomes. Results indicate a need to improve education in young women with T1D prior to commencement of sexual activity.