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Increased risk for pregnant women with diabetes

By Editor
21st October 2016
Audits, Good practice NICE

Many women with diabetes who become pregnant are at a higher risk of complications because of a lack of preparation, according to a report.

The National Pregnancy in Diabetes Audit 2015 looked at over 3,000 expectant mothers with the condition.

The findings suggested that only 46 per cent of those who had type 1 diabetes and 23 per cent of those with type 2 were taking the recommended dose of folic acid prior to conception.

It was also discovered that just 16 per cent of women with type 1 and 38 per cent of type 2 women had blood glucose levels within the recommended range in the critically important early weeks of pregnancy.

Expectant mothers with diabetes, who are not taking the necessary steps to take care of themselves, are putting themselves at risk of congenital abnormalities, stillbirth and large babies.

Stillbirth rates

The report, published by NHS Digital, Diabetes UK and the Healthcare Quality Improvement Partnership (HQIP), found that first contact with antenatal diabetes services was later than recommended for many women.

More than 50 per cent of type 1 and type 2 women expecting a baby had no contact with the specialist team during the first eight weeks of pregnancy.

Despite that, the stillbirth rate amongst women with diabetes has more than halved since comparable figures were published by the Confidential Enquiry into Maternal and Child Health in 2003.

However, it remains much higher than in the overall population – 10.7 per 1,000 births for women with type 1 diabetes and 10.5 per 1,000 for type 2 diabetes, compared with 4.7 per 1,000 in the general population.

A baby dying during the first 28 days of life is also more common when the mother has diabetes.

Neonatal deaths occurred for 8.1 per 1,000 live births where the mother had type 1 diabetes and 11.4 per 1,000 with type 2 diabetes, compared with 2.5 per 1,000 in the general population.

Dr Nick Lewis-Barned, a specialist diabetes physician and clinical lead for the audit, said: “Over 3,000 women and 155 specialist teams worked together to provide information for this report.

“Thanks to them we know that many pregnant women with diabetes have worse outcomes than women without diabetes – and that this is often avoidable.

“The key things that can help to reduce the risks for these women and their babies are easy to identify – taking 5mg folic acid daily starting well before pregnancy, having the best possible glucose control, and stopping any treatments that might cause harm.  At the moment this isn’t happening consistently enough.

“Good information and support from their usual diabetes team when thinking about pregnancy, and contact with specialist antenatal teams before and early in pregnancy, can help women to achieve this.  If these outcomes are to improve we need to find ways to work with women much more effectively to be ready for pregnancy.”

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