Pregestational Diabetes Mellitus: Preconception Care May Improve Outcomes and Save Billions

Dr. Cora Peterson PhD Health Economist at Centers for Disease ControlMedicalResearch.com: Interview with:
Dr. Cora Peterson PhD
Health Economist at Centers for Disease Control

Medical Research: What is the background for this study? What are the main findings?

Dr. Peterson: Women with pregestational diabetes mellitus (PGDM) have increased risk for adverse birth outcomes. Preconception care for women with  pregestational diabetes mellitus reduces the frequency of such outcomes, most likely by improving glycemic control before and during the critical first weeks of pregnancy.

Preconception care for women with  pregestational diabetes mellitus includes the following activities:

  • medical or dietary blood sugar control, blood sugar monitoring, screening and treatment of complications due to diabetes,
  • counseling and education about the risks of diabetes in pregnancy, and
  • using effective birth control or contraceptives until appropriate levels of blood sugar are achieved.

In this study, CDC researchers estimated the number of preterm births, birth defects, and perinatal deaths (death between the time a baby is at least 20 weeks old in the mother’s womb to one week after the baby is born) that could be prevented and the money that could potentially be saved if preconception care was available to and used by all women with  pregestational diabetes mellitus before pregnancy.

Researchers estimated about 2.2% of births (88,081 births each year) in the United States are to women with pregestational diabetes mellitus, including women who know they have diabetes before they become pregnant and those who are unaware they have diabetes. Preconception care before pregnancy among women with known pregestational diabetes mellitus could potentially generate benefits of up to $4.3 billion by preventing preterm births, birth defects, and perinatal deaths. Up to an additional $1.2 billion in benefits could be produced if women who do not know they have diabetes were diagnosed and received preconception care.

Medical Research: What should clinicians and patients take away from your report?

Dr. Peterson: These findings might be useful for states or clinical organizations that are considering new or expanded preconception care programs.

Targeted blood glucose testing among women of reproductive age during existing physician office visits to identify those with undiagnosed diabetes might incur a nominal cost per woman. Once  pregestational diabetes mellitus status is known, information on pregnancy intent and existing birth control methods might assist clinicians in cost-effectively triaging women to preconception care services.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Peterson: This estimate of potential benefit of preconception care for women with  pregestational diabetes mellitus does not account for the cost of preconception care. Delivery models for preconception care services are highly varied. Further study of the cost and associated benefits of preconception care for participating women, as well as women’s compliance with preconception care, is needed. Those future estimates, in combination with the results of this study, could be used to assess the cost-effectiveness of preconception care for women with PGDM.

Citation:

Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States

Peterson, Cora et al.

American Journal of Obstetrics & Gynecology
Published Online: October 28, 2014

DOI: http://dx.doi.org/10.1016/j.ajog.2014.09.009