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High rates of congenital malformations exist in South Western Sydney in women with type 1 and type 2 diabetes.
- Bankstown LGA: 11.6%
- Campbelltown LGA: 11%
- Liverpool LGA: 6.8%
This is compared with the background rate of 2%.
The major factor related to increased congenital malformation rates is poor glycaemic control as measured by HbA1c and glucose monitoring. Other causes include the use of potentially fetotoxic medication and not using high dose folic acid, as recommended.
Current guidelines recommend a HbA1c of 6.5% or below for at least three months before a patient tries to conceive.
Women with a HbA1c above 7.5% are nine times more likely to have congenital malformation, and four times more likely to miscarry than those who have a HbA1c of 6.5% or less.
Patients should be referred to a specialist diabetes in pregnancy clinic as early as possible upon confirmation of pregnancy (before 10 weeks gestation).
Diabetes specific pre-pregnancy counselling and management has been shown to reduce both the congenital malformation rate and perinatal mortality by 50-75% in women with both T1DM and T2DM.
For women with pre-existing diabetes, understanding the risks of unplanned pregnancies, undertaking pre-pregnancy planning to achieve optimal glycaemic control and maintaining this throughout the pregnancy has been shown to significantly increase the likelihood of having a healthy baby.
What can you do?
Identify your female patients who have type 1 or type 2 diabetes who are of childbearing age to engage in a discussion about pregnancy and contraception.
Download factsheet for ways you can support your patients [PDF | 2 pages | 318kb]
Visit HealthPathways for more information
Pre-pregnancy Planning for Type 1 and Type 2 Diabetes - Community HealthPathways South Western Sydney