How Effective are Preconception Care Services for Women with Type 1 or Type 2 Diabetes: A Systematic Review

Introduction: The NICE guidelines provide extensive information on the importance of preconception care for women with type 1 and type 2 diabetes. However, there still remains dispute as to whether it is effective in improving maternal and foetal outcomes. This systematic review aims to establish the effectiveness of preconception care services for women with type 1 and/or type 2 diabetes and to evaluate the factors which prevent women from accessing these services by examining the current primary literature. Methods: This review involved conducting a thorough electronic search of studies using EMBASE, MEDLINE, CINAHL and grey literature. There was limited research in this area and as such, the main types of studies included were randomised controlled trials, population based studies and perspective cohort studies. The primary outcomes were to assess the level of glycaemic control, the uptake rate of women taking folic acid supplementation and the rate of attendance to preconception clinics. Results: In total, six studies with a total of two thousand, two hundred and thirty-four participants were included. The studies revealed varying results regarding the relationship between preconception care and overall pregnancy outcomes. Five out of the six included studies showed an overall improvement in glycaemic control. Only three of the studies showed an improved rate in women taking folic acid; whilst only one study stated the neural tube defect rate. The overall patient participation in preconception care services varied amongst studies due to the differences in social demographics of participants. Conclusions: Preconception care has been noted to improve maternal and foetal outcomes for women with diabetes. The NICE guidelines (2015) have set the standards at which care should be delivered. However the methods in encouraging women from disadvantaged backgrounds needs to be improved. Further qualitative primary research is required to establish how to improve on this and encourage wider participation.