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Cochrane Database of Systematic Reviews

Preconception care for diabetic women for improving maternal and infant health

Information

DOI:
https://doi.org/10.1002/14651858.CD007776.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 11 August 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Pregnancy and Childbirth Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Joanna Tieu

    Correspondence to: ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia

    [email protected]

    [email protected]

  • Philippa Middleton

    Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia

  • Caroline A Crowther

    Liggins Institute, The University of Auckland, Auckland, New Zealand

  • Emily Shepherd

    ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia

Contributions of authors

In this update of the review Emily Shepherd, assessed studies for eligibility and extracted data. Emily Shepherd drafted the first version of the update and all review authors made comments on subsequent drafts and contributed to the final version.

In the previous version of this review Joanna Tieu and Philippa Middleton assessed studies for inclusion and extracted data. Caroline Crowther also consulted on study inclusion and data extraction. The review was written by Joanna Tieu with help and regular feedback from Caroline Crowther and Philippa Middleton.

Joanna Tieu researched and wrote the protocol with aid and regular feedback from Professor Caroline Crowther and Philippa Middleton.

Sources of support

Internal sources

  • ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, The University of Adelaide, Australia.

External sources

  • NHMRC: National Health and Medical Research Council, Australia.

    Funding for the Australian and New Zealand Satellite of Pregnancy and Childbirth

  • NIHR: National Institute for Health Research, UK.

    NIHR Cochrane Programme Grant Project: 13/89/05 – Pregnancy and childbirth systematic reviews to support clinical guidelines

Declarations of interest

Joanna Tieu: is supported by an NHMRC postgraduate scholarship and Arthritis Australia Ken Muirden fellowship (jointly funded by the Australian Rheumatology Association and Roche).

Philippa Middleton: none known.

Caroline A Crowther: none known.

Emily Shepherd: none known.

Acknowledgements

We acknowledge the support from the Cochrane Pregnancy and Childbirth editorial team in Liverpool and the Australian and New Zealand Satellite of Cochrane Pregnancy and Childbirth (funded by NHMRC).

We thank Therese Dowswell and Lambert Felix from Cochrane Pregnancy and Childbirth who provided support for this update. Therese Dowswell assessed studies for eligibility and extracted data. Their contribution to this project was supported by the National Institute for Health Research (NIHR), via Cochrane programme grant funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2017 Aug 11

Preconception care for diabetic women for improving maternal and infant health

Review

Joanna Tieu, Philippa Middleton, Caroline A Crowther, Emily Shepherd

https://doi.org/10.1002/14651858.CD007776.pub3

2010 Dec 08

Preconception care for diabetic women for improving maternal and infant health

Review

Joanna Tieu, Philippa Middleton, Caroline A Crowther

https://doi.org/10.1002/14651858.CD007776.pub2

2009 Apr 15

Preconception care for diabetic women to improve maternal and infant health

Protocol

Joanna Tieu, Philippa Middleton, Caroline A Crowther

https://doi.org/10.1002/14651858.CD007776

Differences between protocol and review

In this update of the review:

  • we have updated our primary and secondary review outcomes to be in line with those standard outcomes that are/will be used in other Cochrane Pregnancy and Chilbirth diabetes in pregnancy reviews (which we have adapted, as appropriate);

  • we have updated the methods in line with those in the standard template used by Cochrane Pregnancy and Childbirth;

  • we have used the GRADE approach to assess the quality of the body of evidence and we have included ’Summary of findings’ tables.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adolescent; Female; Humans; Pregnancy; Young Adult;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

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Methodological quality graph: reviewers' judgements about each methodological quality item presented as percentages across all included studies
Figures and Tables -
Figure 2

Methodological quality graph: reviewers' judgements about each methodological quality item presented as percentages across all included studies

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Methodological quality summary: reviewers' judgements about each methodological quality item for each included study
Figures and Tables -
Figure 3

Methodological quality summary: reviewers' judgements about each methodological quality item for each included study

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Comparison 1 Preconception care versus standard care for diabetic women, Outcome 1 Pregnancy.
Figures and Tables -
Analysis 1.1

Comparison 1 Preconception care versus standard care for diabetic women, Outcome 1 Pregnancy.

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Comparison 1 Preconception care versus standard care for diabetic women, Outcome 2 Behaviour changes associated with the intervention.
Figures and Tables -
Analysis 1.2

Comparison 1 Preconception care versus standard care for diabetic women, Outcome 2 Behaviour changes associated with the intervention.

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Summary of findings for the main comparison. Preconception care versus standard care for diabetic women: outcomes for the woman

Preconception care versus standard care for diabetic women for improving maternal and infant health: women's outcomes

Patient or population: adolescent girls with type 1 or type 2 diabetes
Setting: USA
Intervention: preconception care
Comparison: standard care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with standard care

Risk with preconception care

Pregnancy

Study population

not estimable

109
(1 RCT)

⊕⊝⊝⊝
Very low1,2

No pregnancies reported in 1 RCT

In 2 additional RCTs pregnancy was an exclusion criterion or was not clearly reported

0 per 1000

0 per 1000
(0 to 0)

Hypertensive disorders of pregnancy

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Caesarean section

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Perineal trauma

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Gestational weight gain

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Cardiovascular health

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Induction of labour

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RCT: randomised controlled trial; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1The study had design limitations (‐1).
2No events and small sample size (‐2).

Figures and Tables -
Summary of findings for the main comparison. Preconception care versus standard care for diabetic women: outcomes for the woman
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Summary of findings 2. Preconception care versus standard care for diabetic women: outcomes for the child

Preconception care versus standard care for diabetic women for improving maternal and infant health: child outcomes

Patient or population: adolescent girls with type 1 or 2 diabetes
Setting: USA
Intervention: preconception care
Comparison: standard care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with standard care

Risk with preconception care

Large‐for‐gestational age

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Perinatal mortality

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Death or morbidity composite

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Congenital malformations

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Adiposity

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Type 1 or 2 diabetes

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

Neurosensory disability

Study population

not estimable

(0 studies)

‐

0 per 1000

0 per 1000
(0 to 0)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

Figures and Tables -
Summary of findings 2. Preconception care versus standard care for diabetic women: outcomes for the child
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Comparison 1. Preconception care versus standard care for diabetic women

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pregnancy Show forest plot

1

109

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Behaviour changes associated with the intervention Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Initiating discussions about preconception counselling and reproductive health with diabetes healthcare team: 9‐month follow‐up

1

87

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.02, 0.82]
Figures and Tables -
Comparison 1. Preconception care versus standard care for diabetic women
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