Audit report on pregnancy in diabetes released

By Editor
12th October 2017
Audits, Care planning Charity NICE Pregnancy

Only one in 12 women with diabetes are receiving all three key recommended pre-pregnancy health measures, according to an audit looking at the standard of care in expectant mothers.

The National Pregnancy in Diabetes Audit 2016, published by NHS Digital and supported by Diabetes UK, also showed stillbirth rates are double in women with diabetes and neonatal deaths are more than four times higher, when compared to the general population. Women with type 2 diabetes experienced more neonatal deaths overall – with 21 deaths – compared to 10 deaths experienced by those wth type 1 diabetes.

The findings also suggested nearly half of babies born to women with type 1 diabetes, and nearly a quarter born to women with type 2 diabetes were larger than gestational age (LGA). 

The audit looked at 3,356 pregnancies in 3,297 women across 172 antenatal diabetes services. Of these women, 1,608 had type 2 diabetes.

Other key findings: 

  • Few women were well prepared for pregnancy and only one in twelve women (8 per cent) had achieved HbA1c < 48mmol/mol, use of 5mg folic acid and avoidance of potentially harmful medications before conception.
  • Despite the fact that women with type 2 diabetes have better glucose control, other measures, including use of folic acid, suggest they were not getting the pre- pregnancy care they needed.
  • 24.0 per cent of women with type 1 diabetes and 41.9 per cent of women with type 2 diabetes did not present to the joint diabetes antenatal team before 10+0 weeks gestation. 
This suggests reduced awareness of pregnancy risks and/or failure of diabetes antenatal care and referral pathways.
  • Almost one in 10 women with type 1 diabetes had at least one hospital admission for severe hypoglycaemia.
  • Ketoacidosis, a high risk for mother and fetus, occurred in 2.7 per cent of women with type 1 diabetes.

Douglas Twenefour, Diabetes UK’s deputy head of care, said: “This audit reveals the unacceptable reality that, for too many women living with type 1 or type 2 diabetes, pregnancy remains fraught with unnecessary difficulties for both mother and baby. The clear reason for this is that women – for a number of reasons – are not getting the support they need before and during their pregnancies.

“Diabetes UK wants to see urgent action on this issue; the steps women can take before getting pregnant are clear but the Audit suggests there are still variations in the level of care across services, and that far too many of them are simply not aware of what they can do to protect themselves and their babies.”

Diabetes UK has developed and rolled out the Pregnancy Information Prescription – a tool  to help healthcare professionals to discuss pregnancy preparations with all  women living with diabetes who may become pregnant, and to agree personal action plans to ensure a safe and healthy pregnancy.

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