Association between the introduction of a structured form and the quality of diabetes in pregnancy clinic care

Background: Pregnancy in women with pre‐gestational Type 1 (T1DM) and 2 (T2DM) diabetes can be a clinical challenge. This study assessed the association between introducing a structured diabetes in pregnancy proforma, on the quality of medical record documentation and pregnancy outcomes in women with T1DM and T2DM. Methods: This was a retrospective 2 cycle audit: pre and post proforma introduction. The documentation quality was assessed based upon the rate of missing pre‐pregnancy/first trimester HbA1c, third trimester HbA1c, folate intake and dose, retinopathy and nephropathy progression. Changes in pregnancy outcomes were assessed by mode of delivery, preterm delivery, mean 3rd trimester HbA1c, preeclampsia, and fetal outcomes. Results: The pre‐ and post‐proforma periods included 91 and 41 pregnancies respectively. The quality of documentation improved in the post‐proforma phase with the rate of missing data declining from 63.4% to 36.6% ( p= 0.005) for pre‐pregnancy/1st trimester HbA1c, 30.8% to 12.2% (p= 0.009) for periconceptional folate intake, 42.9% to 14.6% (p= 0.001) for folate dose, 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). Conclusion: The quality of documentation improved significantly which is likely attributable to the implementation of the proforma. This study supports the use of structured documentation to reduce variation in care and potentially improve pregnancy outcomes.