Diabetes knowledge is correlated with improved glucose control outside of pregnancy. However, associations between maternal diabetes knowledge and pregnancy outcomes have not been investigated.METHODS:
This is a prospective cohort study of women with insulin-requiring diabetes enrolled in a team-based diabetes program. Women completed the validated Michigan Diabetes Knowledge Test at their initial visit. 53 women were categorized into high (>75%, N=32), moderate (60-74%, N=13) or low knowledge (< 59%, N=8) groups based on % correct responses. We referred women with low or moderate knowledge to diabetes education courses. The primary outcomes were glycosylated hemoglobin A1c (HbA1c) and a neonatal composite of hypoglycemia, large for gestational age, preterm birth and hyperbilirubinemia requiring phototherapy. All results were analyzed by Fisher exact test or ANOVA as indicated. p<0.05 was considered statistically significant.RESULTS:
All groups had similar baseline characteristics with high, moderate and low knowledge groups having HbA1c of 8.1%, 7.9% and 7.9%, respectively. All three groups achieved an average HgbA1c of less than 6% at time of delivery. 39 women repeated the knowledge test in the third trimester and 71% improved their scores. Neonatal outcomes were similar among the three groups.CONCLUSION:
Regardless of initial knowledge, women enrolled in a team-based diabetes program can achieve excellent glucose control in pregnancy. Similar glucose control at delivery in all groups may be associated with targeted referral to diabetes education programs. Overall, this study provides optimism for diabetes care teams that women with low diabetes knowledge can achieve glucose control in pregnancy.