Education along with the socioeconomic determinants in Type 1 diabetes women are important for pre-pregnancy planning. 

Aim
We aim to access the outcomes of pregnancy in patients in a cluster of T1DM in Northern India


Method
We retrospectively analysed the maternal and the offspring outcomes in 20 type 1 diabetic patients who were provided the pre-pregnancy counselling at the Centre for Diabetes and Endocrine in urban setting in North India

Results
The participants (n=20) were on continuous basal bolus regimen with mean age of conception of 29.2 years (22 to 35 yrs) with the average duration of diabetes of 19.5 years (5 to 44 yrs). Half of the pregnancy were unplanned. All of them had conceived naturally except one who underwent IVF treatment because of polycystic ovarian disease. Analysis of maternal outcomes revealed that only 10 T1DM were evaluated for prenatal HbA1c. Frequency of blood sugar monitoring was mean 2 pricks / day (1/7 days- 6 times /day). Average weight gain during pregnancy was 3.2 kg (3.4 to 10 kg). 18 deliveries were by the elective caesarean section at mean 32 weeks (28-40 weeks) of gestation. Offspring follow up reveal, the average birth weight was 2.6 kg (1 to 3.75 kg). Only one baby was < 5th percentile for weight and two were >90th percentile for weight. Eleven of them had stay in ICU with mean of 7.2 days (1-125 days) mainly for hypoglycaemia except for two, who had hyperbilirubinemia. Appropriate focus for age at marriage, age at conception were analysed for the association of the pre-natal, inter natal and post-natal maternal outcome and offspring outcome parameters like birth weight, hospital stay.

Discussion
Despite of delay in marriage and late age at conception, decrease frequency of HbA1c and SMBG, the offspring outcome was satisfactory. 

Since 50% pregnancies were unexplained, more, emphasis is required on education. The most common mode of delivery was caesarean section, which could be perhaps due to the over cautious approach by the gynaecologists. We propose a EGP (Education-Gynaecologist-Physician) model to achieve an improved offspring and peri-natal outcome, encompassing a holistic multi -pronged approach with the better education of the patients, greater awareness and involvement of the gynaecologist, with the greater role played by the physician is important to maintain a good metabolic control.

Twenty years follow up for offspring outcomes in twenty type 1 diabetic patients with pregnancy