Egan Aoife M, Danyliv Andriy, Carmody Louise, Kirwan Breda, Dunne Fidelma P
Galway Diabetes Research Centre (A.M.E., L.C., B.K., F.P.D.) and Department of Economics (A.D.), National University of Ireland Galway, Galway, Ireland.
J Clin Endocrinol Metab. 2016 Apr;101(4):1807-15. doi: 10.1210/jc.2015-4046. Epub 2016 Feb 26.
Only a minority of women with diabetes attend prepregnancy care service and the economic effects of providing this service are unclear.
The objective of the study was to design, put into practice, and evaluate a regional prepregnancy care program for women with types 1 and 2 diabetes.
This was a prospective cohort and cost-analysis study.
The study was conducted at antenatal centers along the Irish Atlantic Seaboard.
Four hundred fourteen women with type 1 or 2 diabetes participated in the study.
The intervention for the study was a newly developed prepregnancy care program.
The program was assessed for its effect on the risk of adverse pregnancy outcomes. The difference between program delivery cost and the excess cost of treating adverse outcomes in nonattendees was evaluated.
In total, 149 (36%) attended: this increased from 19% to 50% after increased recruitment measures in 2010. Attendees were more likely to take preconception folic acid (97.3% vs 57.7%, P < .001) and less likely to smoke (8.7% vs 16.6%, P = .03) or take potentially teratogenic medications at conception (0.7 vs 6.0, P = .008). Attendees had lower glycated hemoglobin levels throughout pregnancy (first trimester glycated hemoglobin 6.8% vs 7.7%, P < .001; third trimester glycated hemoglobin 6.1% vs 6.5%, P = .001), and their offspring had lower rates of serious adverse outcomes (2.4% vs 10.5%, P = .007). The adjusted difference in complication costs between those who received prepregnancy care vs usual antenatal care only is €2578.00. The average cost of prepregnancy care delivery is €449.00 per pregnancy.
This regional prepregnancy care program is clinically effective. The cost of program delivery is less than the excess cost of managing adverse pregnancy outcomes.
只有少数糖尿病女性接受孕前保健服务，提供该服务的经济影响尚不清楚。
本研究的目的是设计、实施并评估一项针对1型和2型糖尿病女性的区域孕前保健计划。
这是一项前瞻性队列研究和成本分析研究。
该研究在爱尔兰大西洋沿岸的产前中心进行。
414名1型或2型糖尿病女性参与了研究。
本研究的干预措施是一项新开发的孕前保健计划。
评估该计划对不良妊娠结局风险的影响。评估计划实施成本与未参与者治疗不良结局的额外成本之间的差异。
共有149名（36%）女性参与：在2010年增加招募措施后，这一比例从19%增至50%。参与者更有可能在孕前服用叶酸（97.3%对57.7%，P<.001），吸烟的可能性较小（8.7%对16.6%，P=.03），或在受孕时服用潜在致畸药物的可能性较小（0.7对6.0，P=.008）。参与者在整个孕期糖化血红蛋白水平较低（孕早期糖化血红蛋白6.8%对7.7%，P<.001；孕晚期糖化血红蛋白6.1%对6.5%，P=.001），其后代严重不良结局的发生率较低（2.4%对10.5%，P=.007）。接受孕前保健与仅接受常规产前保健的患者在并发症成本方面的调整差异为2578.00欧元。每次妊娠孕前保健的平均成本为449.00欧元。
该区域孕前保健计划在临床上是有效的。计划实施成本低于管理不良妊娠结局的额外成本。
