Project 455874

Women with diabetes mellitus before pregnancy are thought to be at a higher risk of miscarriage, stillbirth and need for abortion; their newborns are at higher risk of dying or having a birth defect ("congenital anomaly"). Similarly, women with pre-pregnancy diabetes are themselves considered to be at risk higher risk of developing a serious infection in pregnancy, needing to visit the emergency department, or having heart disease and kidney disease later in life. It is currently recommended that average blood sugar levels before pregnancy are kept close to normal, reflected by a lower blood "A1c" concentration - an inexpensive test readily available all over Canada. Yet, it is unknown whether a higher A1c before pregnancy can identify women at risk of the aforementioned various adverse outcomes, and, importantly, to what degree a decline in A1c from shortly before conception to that early in pregnancy can reduce the risk of these many outcomes. In the currently proposed series of studies, we will use existing large healthcare datasets to study about 6000 women across Ontario with pre-pregnancy diabetes. Working with our national partners in obstetrics and diabetes care, we intend to apply our findings to better the use of A1c to identify women at higher risk of adverse outcomes, and potentially reduce the risk of these important outcomes. Our research aims to improve the lives of women with diabetes, and to provide them with the best opportunity for a healthy transition from pregnancy into motherhood, while doing the same for their unborn and newborn child.