Background:
The proportion of congenital malformations in the offspring of pregnant women with poorly controlled diabetes is 6-9%. Women with diabetes plan their pregnancies less often (34-41%) compared to the general population (51%). Pregnancy planning and glycemic control in women with diabetes during preconception have been shown to decrease risks.

Objectives:
The purpose of this study was to evaluate the quality of preconception care and pregnancy outcomes of diabetic women at Kaiser Permanente, Northern California (KPNC) comparing intended vs. unintended pregnancies. The goal was to learn about contraception use before and after a pregnancy, self-reported pregnancy intention, quality of preconception glucose control, and pregnancy outcomes.

Methods:
We conducted a retrospective cohort study using electronic databases and chart review of KPNC female members with pre-existing diabetes in 2004. The cohort was identified through the KPNC Division of Research Diabetes Mellitus Registry and prenatal records with self-reported pregnancy intent in the prenatal record. We linked this data to delivery records, lab data (HbA1c) and pharmacy records.

Results:
Of the 95 diabetic women in the final cohort, 70% of the women had a planned pregnancy, with 54%% of the unintended group using less effective or no contraception within the 12 months preceding the pregnancy. In the entire cohort, 82% were married, 42% Hispanic, and 24% had a least some college education. During preconception, the mean HgbA1c was 7.65 for the intended group and 8.65 for the unintended group. Thirty-eight percent had a baseline weight of ≥201 pounds, with 30% of the intended pregnancies versus 14% unintended having baseline weights under 160. Thirty-two percent had labor induced and 58% had cesarean sections. Ninety-eight percent delivered live births between 36 and 40 weeks gestation. Twenty-eight percent of newborns had a birth weight of ≥4000 grams. Thirty-seven percent of diabetic women had evidence of very effective contraception after the pregnancy.


Conclusion and implications for practice:
In a managed care setting, diabetic women had a greater percent of planned pregnancies than the literature has demonstrated. There was less evidence of glycemic control or adequate contraception use in women not planning their pregnancy. These results highlight the importance of preconception care for diabetic women of reproductive age.