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Study flow diagram
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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
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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
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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.
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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.
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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).

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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

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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]
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Comparison 1. Preconception care versus standard care for diabetic women
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