The Power of Small Conversations: Bridging the Gap Between Diabetes and Pregnancy Planning

Despite the established importance of preconception counselling among women with pre-existing diabetes, many Canadian women of this demographic continue to report inadequate medical planning of pregnancy. Primarily due to the teratogenic effects of hyperglycemia in the early weeks of pregnancy, minimizing the risk of adverse pregnancy outcomes requires a proactive approach toward medical optimization before conception. Primary care providers are well placed to provide preconception counselling to reproductive age women with pre-existing diabetes to alert them to the importance of pregnancy planning. This counselling may not necessarily require dedicated visits but may take the form of simple check-ins and key messages interspaced between other interactions. Herein we discuss the importance and challenges of preconception counselling among women with pre-existing diabetes and provide a pragmatic approach to the delivery of preconception counselling among primary care providers.

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): An Emerging Relationship With Pregestational Diabetes Mellitus Among First Nations and Non-First Nations People in Saskatchewan-Results From the DIP: ORRIIGENSS Project

OBJECTIVES

Because congenital anomalies of the kidneys and urinary tract (CAKUT) represent a frequent cause of end stage renal disease (ESRD) in the young, we explored the epidemiology of CAKUT and the role of diabetes in pregnancy.

METHODS

This was a retrospective cohort study of CAKUT, by maternal diabetes status, from among all 1980‒2009 births in Saskatchewan First Nations (FN) and non-First Nations (non-FN) people. We determined frequencies, predictors and complications of CAKUT, as well as cumulative survival (to 2014) of affected persons until ESRD and death.

RESULTS

Of the 411,055 babies (204,167 mothers) in the Saskatchewan maternal-infant database, 2,540 had CAKUT (391 FN and 2,149 non-FN). Overall annual CAKUT incidence was 0.63% for non-FN and 0.57% for FN (p=0.082), but 5-year CAKUT incidence only increased among FN (0.40% in 1980‒1984 and 0.76% in 2005‒2009, p<0.0001) and was highest among offspring of FN mothers with pregestational diabetes (pre-G/DM) (0% before 1995, 2.51% in 2000‒2004 and 1.66% in 2005-2009). Pre-G/DM, but not gestational diabetes mellitus (GDM), was an independent predictor of CAKUT in non-FN (odds ratio, 1.79; 95% confidence interval, 1.20 to 2.69), and in FN interacting with maternal history of stillbirth (odds ratio, 7.90; 95% confidence interval, 1.14 to 54.6). ESRD was >100-fold more likely among offspring with CAKUT compared with all other offspring and was responsible for 40% of ESRD cases in young FN and non-FN people.

CONCLUSIONS

In Saskatchewan, pre-G/DM is an emerging cause of CAKUT, accounting for 40% of ESRD cases in FN/non-FN children and young adults. Because pre-G/DM‒related CAKUT is potentially preventable with optimal glycemic management, increased recognition of this serious complication is required.