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Key findings of latest diabetes pregnancy audit shared

By Editor
12th October 2019
Audits, Pregnancy

Rates of preterm births, large for gestational age and neonatal care admissions were significantly higher for women with third trimester HbA1c levels of 48 mmol/mol or above, according to the National Pregnancy in Diabetes (NPID) Audit Report 2018.

Babies born to mothers with lower glucose levels had healthier outcomes, according to the latest results of the NPID, which is the largest continuous audit of pregnancy in women with diabetes in the world, with more than 4,400 pregnancies in 2018.

The report, published on October 10 by NHS Digital, has issued a series of recommendations, including implementing and testing new pathways and treatments, regionally and nationally.

Diabetes and pregnancy outcomes are expected to improve with the NHS due to provide continuous glucose monitors to all women with type 1 diabetes during pregnancy by 2021, according to the The NHS Long Term Plan.

The audit, which covers England, Wales and the Isle of Man, is a measurement system to support improvement in the quality of care for women with diabetes who are pregnant or planning pregnancy and seeks to address three key questions:

  • Were women with diabetes adequately prepared for pregnancy?
  • Were adverse maternal outcomes during pregnancy minimised?
  • Were adverse fetal/infant outcomes minimised?

Key findings

Characteristics of mothers

Over half of women, included in this audit, in England and Wales for 2018 have type 2 diabetes.

Few women were well prepared for pregnancy

Overall 7 out of 8 women were not well prepared for pregnancy. Women with type 2 diabetes are more likely to have HbA1c below 48mmol/mol and women with type 1 diabetes are more likely to be taking folic acid 5mg daily. This has not changed since 2014.

Presentation before 10+0 weeks of pregnancy

Most women with type 1 diabetes and just over half of women with type 2 diabetes are seen within 10 weeks’ gestation. This has not changed since 2014. There is significant unit to unit variation in presentation before 10 weeks.

Maternal adverse risks and events in pregnancy

Increase in the rate of admissions with hypoglycaemia for women with type 1 diabetes.

Almost one in two babies had complications related to maternal diabetes

This is mostly the result of large for gestational age (LGA) babies. There are higher rates of anomalies, stillbirths and neonatal deaths (98.6% live births) than in the non-diabetes population (99.6% live births). These remain unchanged over the time of the audit.

Admissions to neonatal units are more common than in the general population

Neonatal unit admissions are high for the babies of women with diabetes, especially for those who are born between 34 and 37 weeks. Full term babies of mothers with type 1 diabetes are more likely to be admitted to neonatal units than babies of mothers with type 2 diabetes.

Adverse outcomes – stillbirths

  • Stillbirth rates in the NPID audit were 13.7 per 1,000 total births in 2018 across all diabetes types, compared with 4.2 per 1,000 total births in 2017 in the general population of England and Wales.
  • Although there was an increase in the number of stillbirths, this is proportional to the increase in the number of records submitted to NPID.
  • There was no significant change in the overall stillbirth rate in the NPID population between 2014 and 2018 although there are higher rates of stillbirths in type 2 diabetes since 2016.

The NPID is a workstream of the National Diabetes Audit (NDA) and is managed by NHS Digital under an agreement with the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh Government.

The NDA is delivered by NHS Digital, in partnership with Diabetes UK and the National Cardiovascular Intelligence Network (part of Public Health England).

To access the latest report, click here.

Picture credit: Suhyeon Choi

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