Care remains poor for pregnant women with diabetes

Care remains poor for pregnant women with diabetes

It found poor glucose management and little preconception use of folic acid, as well as a high rate of macrosomia; but the proportion of babies being taken into special care has fallen dramatically over the past decade or so. Experts are calling for local initiatives to reduce pregnancy risk in women with diabetes.

Auditors for the National Pregnancy in Diabetes (NPID) Audit Report 2013, which is managed jointly by the Health and Social Care information Centre and charity Diabetes UK, looked at the implementation of national guidance on the care of women with diabetes who become pregnant, across England and Wales. They found that improvements are needed in pregnancy preparation, care and outcomes for women with diabetes.

They reported that among the 1,700 cases audited:

- just 5% of women with type 1 diabetes and 19% of those with type 2 diabetes met the national target for blood glucose levels in the first trimester (i.e. HbA1c ≤6.1%), set by the National Institute for Health and Care Excellence

- only 40% had been taking folic acid supplements prior to conception

- nearly half (46%) of women with type 1 diabetes and a quarter (23%) of those with type 2 diabetes had a baby that was large for gestational age

- 9% of women with type 2 diabetes were still taking potentially harmful blood glucose medications when they conceived

- only three in ten babies needed intensive or specialist neonatal care, compared with 57% in a 2002-03 survey.

In 2005, the Confidential Enquiry into Maternal and Child Health (CEMACH) published its study of pregnancies in women with diabetes in 2002-03, which identified critical deficiencies in preparation for pregnancy, care during pregnancy and outcomes. NIPD 2013’s lead clinician and advisory group chair, Dr Nick Lewis-Barned, expressed disappointment at the fairly poor rate of improvement over the past decade. He said: “For the first time we are able to measure how the national guidance around pregnancy management in women with diabetes, which was produced in response to the CEMACH report in 2005, is working throughout England and Wales.

“It is encouraging that some aspects of pregnancy preparation and care have improved to some extent since then, but this audit has also highlighted that this progress is at best modest.”

He went on: “The majority of women with diabetes in England and Wales enter pregnancy with avoidable increased risk, and many have unsatisfactory glucose control during pregnancy. This puts their fetus and themselves at further risk. Improving this will require collaboration between local service providers across public health, primary and specialist care and a clear plan for change.

“Every diabetes healthcare community and maternity service needs to respond by developing local improvement initiatives to reduce pregnancy risk.”

by Louise Prime

OnMedica, Thursday 09 October 2014

View this article