Background: Pregnancy in women with pre-gestational Type 1 and 2 diabetes is a rapidly rising clinical challenge. Pregnancies among women with pre-gestational diabetes (PGD) carry a high risk of adverse outcomes. Optimal management of diabetes in pregnancy requires a structured clinical approach. The primary objective of this study was to evaluate the impact on the quality of documentation of healthcare data and the secondary objective was to determine whether using the proforma was associated with improved maternal and fetal outcome in women with pre-gestational diabetes.
Methods: This was a retrospective 2 cycle audit on women with PGD with births between January 2010 and December 2017. The proforma was introduced in January 2016 and a washout period of 5 months from January 2016 to May 2016 inclusive was defined. The patients’ notes and electronic medical records were reviewed. The quality of documentation was assessed based on the rate of missing data. Data were analysed using Fisher’s exact and ANOVA tests.
Results: 91 and 41 pregnancies were evaluated in the pre and post proforma period respectively. The quality of documentation significantly improved in post-proforma phase with the rate of missing data declining from 100% to 31.7% (p<0.001) for retinopathy progression, 92.3% to 19.5% (p<0.001) for nephropathy progression, and 31.9% to 7.3% (p= 0.016) for 3rd trimester HbA1c. Macrosomia significantly reduced in the second cycle (49% vs 21% p=0.003). Rates of caesarean section (54% vs 45% p=0.441), preeclampsia (12% vs 5% p=0.324) and mean 3rd trimester HbA1c (6.8% vs 6.4% p=0.155) were not significantly different.
Conclusion: The quality of documentation improved significantly for a number of variables studied which is likely attributable to the implementation of the proforma. The introduction of the proforma was also associated with a significant reduction in the rate of macrosomia. This was a small study, but it supports the use of structured documentation to help reduce variation in care and potentially improve pregnancy outcomes.