Pregnant women with diabetes are ‘poorly prepared’
Three out of four pregnant women with diabetes “have higher than recommended blood glucose levels”, according to a new report.
The National Pregnancy in Diabetes (NPID) audit, which is managed by the Health and Social Care Information Centre in partnership with Diabetes UK and supported by Public Health England, looked at 2,537 women with diabetes who were pregnant in England and Wales in 2014.
The findings showed that 85 per cent of women with type 1 diabetes and 64 per cent with type 2 had higher than recommended blood glucose levels, which increases risk of stillbirth, neonatal death and babies being born with congenital abnormalities.
It also showed that half of women with type 1 and two thirds of women with type 2 are not taking folic acid when they become pregnant.
The clear message of this report is that many women with diabetes are not getting the advice and support they need when it comes to planning to become pregnant
The report said the findings found that “women were generally poorly prepared for pregnancy, whether this is assessed based on folic acid use prior to pregnancy, HbA1c levels in the first trimester, or avoidance of potentially harmful treatments such as statins, ACE inhibitors and ARBs”.
It is important that women with diabetes who want to get pregnant take a higher dose of folic acid than women without the condition.
The NICE recommended dose can only be prescribed by a doctor or nurse and is not available over the counter. In addition to this, one in 10 women with type 2 are taking medication when they become pregnant that is potentially harmful to the baby.
It is also recommended by NICE that women with diabetes who become pregnant should be offered immediate contact with a joint diabetes and antenatal clinic.
‘Healthy pregnancies’
The audit found that 52.0 per cent of women with type 1 diabetes had their first contact with the specialist antenatal diabetes team prior to eight weeks gestation, but only 36.7 per cent of women with type 2 diabetes had their first contact with the team within this time.
The audit’s lead clinician, Dr Nick Lewis-Barned, is now calling for local diabetes teams, general practices and maternity services to work together to help increase awareness among women with diabetes that high blood glucose levels and a lack of preparation for pregnancy can increase the risk of adverse pregnancy outcomes.
Dr Lewis-Barned said: “There are three key elements of pregnancy preparation for women with diabetes to reduce the risk of adverse pregnancy outcomes – good control of blood glucose levels, taking folic acid supplements and a medication review. It’s clear from the audit that many women need more information and more support in all of these areas.
“This means we need to work much more effectively on improving links between policy makers, commissioners, acute trusts, clinical teams, and local general practices and the community to ensure that women get the support they need to have healthy pregnancies.”
Diabetes UK, which is the leading charity for the condition that connects with and campaigns on behalf of all people affected by diabetes, has called for there to be more support for pregnant women.
Chris Askew, chief executive of Diabetes UK, said: “It is deeply worrying that so many women with diabetes do not have their condition under control during the early stages of pregnancy, as this is putting the health of the baby at risk.
“The clear message of this report is that many women with diabetes are not getting the advice and support they need when it comes to planning to become pregnant and the stark fact is that in too many cases this is leading to tragic consequences such as death or disability of the baby with a third of babies born to mothers with diabetes needing intensive or specialist neonatal support.
‘Act urgently’
“The NHS needs to act urgently to make sure all women with diabetes, who might become pregnant, are aware of the risks of having high blood glucose levels in early pregnancy and are supported by specialist healthcare professionals to achieve good blood glucose control.
“It is also important that doctors and nurses review medications being taken by women with diabetes who want to become pregnant. With good planning and the right care and support in place, women with diabetes can have healthy pregnancies and healthy babies.
“We also must get the message out to women with diabetes that it is really important that they need to plan and take the necessary steps before becoming pregnant to ensure the health of their unborn baby. This means that contraception is essential for women who are not planning to become pregnant, and women who are considering having a baby should speak to their diabetes team as early as possible so they can be supported in taking those all-important measures to ensure a healthy pregnancy and baby.”
The report stated that because pregnant women are only seeking healthcare advice, once they have fallen pregnant, that there is a “need to develop a focus on pregnancy preparation”.
Some of the suggestions include working with primary care teams to identify and inform all women with diabetes who might become pregnant about the importance of safe effective contraception and pregnancy planning and also to ensure there are structured education programmes for all women with diabetes in the relevant age bracket.
The report is guided by an advisory group of obstetricians, midwives, diabetes specialist nurses, diabetologists, public health physicians and patient representatives.