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Mums-to-be with diabetes ill-prepared to cope with increased complications risk

Poorly controlled blood sugar, low uptake of folic acid, late access to care, national audit shows

Caroline White

Friday, 21 October 2016

Mums-to-be with diabetes are ill-prepared to cope with the increased risk of complications they face during their pregnancy, indicates a report published today by NHS Digital, the charity Diabetes UK, and the Healthcare Quality Improvement Partnership.

The National Pregnancy in Diabetes Audit 2015, which measures the quality of care and outcomes for women with diabetes who are pregnant or planning pregnancy, found that few women with diabetes who become pregnant are well prepared, despite agreed national guidelines, putting them at heightened risk of congenital abnormalities, stillbirth, and large babies.

An audit of over 3,000 pregnant women with diabetes showed that less than half (46%) with type 1 diabetes and only around a quarter (23%) with type 2 diabetes were taking the recommended 5 mg of folic acid before conception. 

Most women also had poorly controlled blood glucose, with just 16% of those with type 1 and 38% of those with type 2 diabetes having levels within the recommended range in the critically important early weeks of pregnancy.

First contact with antenatal diabetes services was also later than recommended for many women. Over half (55%) of women with type 1 diabetes and a third (36%) of those with type 2 diabetes had no contact with an antenatal diabetes specialist team during their first 8 weeks of pregnancy.

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

But it is still much higher than in the overall population, the report shows: 10.7 per 1,000 births for women with type 1diabetes 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: “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 5 mg 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.”

He added: “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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