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Care for pregnant women with diabetes ‘must be’ improved say researchers

By Editor
16th February 2018
Audits, Care planning Pregnancy Type 1 diabetes Type 2 diabetes

More needs to be done to improve prenatal care for women with type 1 and type 2 diabetes, researchers who studied data from the UK’s National Pregnancy in Diabetes Audit (NIPD) have said.

They also discovered substantial variation of care in clinics across England and Wales suggesting there is significant room for improvement.

The aim of the study was to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. Three years of NPID data was reviewed, as well as diabetes and obstetric literature.

The authors of the Diabetic Medicine analysis said little change was found in the approach taken by the women with diabetes too. The findings suggested those with type 2 diabetes remain less likely to take 5 mg preconception folic acid and are more likely to take potentially harmful medications, such as statins and/or ACE inhibitor than women with type 1 diabetes.

However, the study also showed women with type 1 diabetes are less likely to achieve the recommended glucose control target of HbA1c.

Significant increase

There has been a significant increase in the proportion of pregnant women with type 2 diabetes from 27 per cent in 2002–2003 to 50 per cent currently. During 2016 there were, for the first time, more babies born to women with type 2 diabetes than to women with type 1 diabetes.

The benefits of pre-pregnancy care are well established, with fewer adverse maternal–fetal outcomes among women who are prepared for pregnancy compared with those who are not. However, the statistics unveiled less than half of women with diabetes attend pre-pregnancy care, potentially putting their health and their baby’s at risk.

Researchers suggested a series of recommendations which would provide an opportunity to make improvements. These included integrating reproductive health into the diabetes care plans of all women with diabetes aged 15–50 years, developing more innovative approaches to improve the uptake of pre-pregnancy care in women with type 2 diabetes in primary care settings and to integrate insulin pump, continuous glucose monitoring and automated insulin delivery technologies into the pre-pregnancy and antenatal care of women with type 1 diabetes.

They also suggested improvements to postnatal care should be made, offering personalised approaches which target women with previous pregnancy loss, congenital anomaly and perinatal mortality.

They concluded: “A nationwide commitment to delivering integrated reproductive and diabetes healthcare interventions is needed to improve the health outcomes of women with diabetes.”

To read the study, click here.

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