Pre-gestational diabetes: benefits and barriers to attendance at pre-pregnancy clinics

Background: Pre-gestational diabetes mellitus increases the risk of adverse pregnancy outcomes. Pre-pregnancy clinics are a well-established and cost-effective way of reducing pregnancy complications. Aims: This study aimed to review outcome differences between women with pre-gestational diabetes who did/did not attend pre-pregnancy clinics and to evaluate barriers to attendance. Methods: A retrospective study examined data from all women with pre-gestational diabetes who received obstetric care in Cork University Maternity Hospital 2015–2019. A cross-sectional survey of women attending antenatal clinics during the study period. A telephone questionnaire was completed to understand facilitators and barriers to pre-pregnancy attendance. Results: Two hundred women were included retrospectively: 65.5% with Type1 diabetes, and 30.5% with type 2 diabetes. Only 26% (52) attended pre-pregnancy clinics. Although there were no differences in miscarriage rate, congenital anomaly, mode of delivery or neonatal intensive care unit admission between groups, the mean birth weight of babies born to women who attended pre-pregnancy clinics was less than those who did not attend (3294.5 ± 753.0 g vs. 3598.8 ± 802.8 g; p = 0.02). Twenty-eight women were included cross-sectionally, nine of whom attended pre-pregnancy clinics. All who attended found it useful. Eight participants proposed a hybrid clinic model to optimise future service engagement. Increasing awareness was advocated by many participants. Conclusion: Attendance at pre-pregnancy clinics is low. Lack of awareness is the greatest barrier reported to attendance. To optimise perinatal outcomes, efforts are required to increase attendance; this may be facilitated by increasing awareness of these clinics, as suggested by the women themselves.