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Diabetes in Pregnancy - Perinatal Aggregated Data (DPAD)WHO European Pilot Project

The obstetrical quality development project (OBSQID) of the WHO Europe is aimed at continuously and effectively promoting the concept of quality management in perinatology through data collection, analysis and provision of benchmarks; demonstrating best practice and the most rational use of technology; and dissemination of acquired knowledge and expertise by participating centres. Consensus has been achieved across Europe on obstetric health indicators and variables, and collection tools developed for aggregated and case based data. Case-based data are submitted to the nodes, which anonymize the data, and provide feedback to users as well as the opportunity for self-analysis and intersite comparison of outcomes. Through such comparisons, health care facilities and health care providers may be motivated to continually improve their outcomes and the quality of care provided. Aim: to summarize the data so far collected, giving preliminary results of the pilot project of the DPAD - Diabetes Perinatal Aggregated Data Sheet, analysis and feedback to data submitters. Subjects and methods: 21 centres (11 local, 6 regional and 2 national) provided diabetes in pregnancy aggregated form containing 20 variables, with a total 141,259 deliveries of which 4870 were complicated with diabetes. Results: out of diabetic pregnancies analyses, pre GDM pregnancies were represented by 32% and GDM 68%. Pre-pregnancy counselling rate ranged between 0%-92%. The caesarean section rate was between 11% and 76% for GDM and 29% and 85% for pre-GDM. The incidence of macrosomia was 15% and 16% in the GDM and pre-GDM groups respectively. Major anomalies were present in 1.5% and 6% of the GDM and pre-GDM groups respectively. Conclusions: according to the St Vincent Declaration (SVD) Diabetes Programme, the ultimate goal for the management of the pregnancy complicated by diabetes should be an outcome for both mother and infant approaching that of the nondiabetetic population. Establishment of an cross national database is imperative for the comparison and continuous evaluation of outcomes, and serves the goal of optimising treatment and outcome in diabetic pregnancies. The OBSQID Project focused on the establishment of a pan-European database on diabetic pregnancies. This pilot demonstrates the power supplied to clinicians by the data evaluation of outcomes. It also implies that efforts should be directed towards the recruitment of more perinatal centers willing to share their data and establish a pan-European data base of diabetic pregnancy. This will allow a more accurate evaluation of management and thus will result in better outcome for the mother and the offspring.

Databases; multicentric study; quality control; WHO; diabetic pregnancy

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