Team-based preconception care through collaboration between maternal-fetal medicine specialists and endocrinologists in women with diabetes

BACKGROUND: Preconception care (PCC) is essential for women with diabetes to reduce adverse perinatal outcomes, including congenital anomalies. However, the effectiveness of a team-based PCC approach involving both maternal-fetal medicine (MFM) specialists and endocrinologists has not been well established. This study aimed to evaluate whether team-based PCC improves the achievement of key PCC targets compared with conventional PCC. METHODS: This retrospective cohort study included women with pregestational diabetes who delivered at a tertiary perinatal center between 2014 and 2022. Team-based PCC was defined as ≥6 months of preconception care jointly provided by MFM specialists and endocrinologists, whereas conventional PCC was provided by endocrinologists alone. Primary outcomes were HbA1c levels, achievement of the target HbA1c (<6.5%), and preconceptional folic acid use at the first prenatal visit. Secondary outcomes included maternal characteristics and perinatal outcomes. RESULTS: A total of 135 pregnancies were analyzed (team-based PCC: n=53; conventional PCC: n=82). Maternal age was similar between the groups; however, women in the team-based PCC group had lower rates of obesity and primiparity. The team-based PCC group showed significantly lower HbA1c levels (6.4±1.0% vs 7.4±1.6%, p<0.0001) and higher rates of achieving the target HbA1c <6.5% (62% vs 32%, p=0.0005). Preconceptional folic acid use was also more frequent (66% vs 7%, p<0.0001). The first prenatal visit occurred earlier in the team-based PCC group. Cesarean delivery and large-for-gestational-age rates were lower in the team-based PCC group. Subgroup analyses suggested comparable or greater benefits of team-based PCC in women with type 2 diabetes. CONCLUSIONS: Team-based PCC involving MFM specialists and endocrinologists significantly improved the achievement of key PCC targets and may contribute to improved perinatal outcomes. This collaborative approach should be promoted for women with diabetes of reproductive age.