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Audit reveals deficiencies in care and outcomes for pregnant diabetics

A new audit into pregnancy in women with diabetes has identified serious deficiencies in pregnancy preparation, care and outcomes.

One of the key findings of the National Pregnancy in Diabetes (NPID) Audit Report 2013 was that only 5% of women with Type 1 diabetes and 19% of women with Type 2 diabetes achieved the target blood glucose readings for early pregnancy set out in national guidelines.

Women with diabetes are at higher risk of adverse pregnancy outcomes such as stillbirths, neonatal deaths and babies born with congenital anomalies. They are also likely to have larger babies. Managing blood glucose is one of the main ways to minimise the risk of adverse outcomes, glucose levels should be monitored as part of pregnancy preparation and throughout the pregnancy.

Audit lead clinician and advisory group chair, Dr Nick Lewis-Barned, said: “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.”

The NPID report includes data collected from 1,700 pregnancies across 128 participating organisations across England and Wales. The key findings also show that only 40% of women with diabetes were taking folic acid supplements prior to pregnancy and that 9% were taking blood glucose medications that may be harmful in pregnancy at the time they became pregnant.

It also showed that almost half (46%) of women with Type 1 diabetes and 23% of women with Type 2 diabetes had a baby that was large for the length of pregnancy.

Louise Silverton, director for midwifery for the Royal College of Midwives, said: “Diabetes is a growing problem. For many pregnant women developing Type 2 diabetes, this is related to an increase in maternal obesity. Midwives need to be able to spend more time with women so that they can do more to discuss the importance of planning during pregnancy. Women especially need information about the importance of having good glucose control before and during the early stages of pregnancy. Before becoming pregnant, they should also be prescribed large doses of folic acid and be aware of treatments that should be avoided during pregnancy.

“This report highlights that there is a big role for midwives in supporting women with diabetes throughout their pregnancy. There are significant risk factors for these mothers, such as experiencing a stillbirth and having a baby with a congenital abnormality. Also babies of diabetic mothers are at risk of being large for their gestational age. These factors all highlight why monitoring and controlling diabetes before and during pregnancy is vital.”

The NPID audit, managed by the Health and Social Care Information Centre in partnership with Diabetes UK supported by Public Health England, is the first continuous national audit that measures the implementation of national guidance on the care of women with diabetes who become pregnant. It forms part of the National Clinical Audit programme, commissioned by the Healthcare Quality Improvement Partnership.

(Image: c. David Jones/Press Association)

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