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Audit reveals gaps in pregnancy care for diabetes patients

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Diabetes experts have called for urgent action to improve care for pregnant women with the condition, after an audit that suggests many are not getting the right support.

The National Pregnancy in Diabetes Audit 2016, carried out by NHS Digital, shows many pregnant women with type 1 and type 2 diabetes had not taken key steps to support a healthy pregnancy or received specialist advice early on.

“For too many living with diabetes, pregnancy remains fraught with unnecessary difficulties”

Douglas Twenefour

The audit looked at 3,356 pregnancies in 3,297 women last year across 172 antenatal diabetes services in England, Wales and the Isle of Man.

Guidance from the National Institute for Care and Excellence recommends pregnant women with diabetes should be offered an immediate appointment with a joint diabetes and antenatal clinic.

However, the report showed a quarter of those with type 1 diabetes and 42% of women with type 2 diabetes were not seen in specialist clinics before 10 weeks.

To support a healthy pregnancy, NICE also recommended that women keep control of their blood glucose, take a high dose supplement of folic acid, and review any medication they are taking.

But just one in 12 women – or 8% – achieved all three of these pre-pregnancy health measures, the audit revealed.

When it came to health complications, the report showed one in 10 women with type 1 diabetes were admitted to hospital at least once for severe hypoglycaemia, while ketoacidosis – a high risk for both mother and unborn children – occurred in 2.7% with type 1.

Meanwhile, the report showed stillbirths were twice as high among women with diabetes, compared to the general population. The rate of neonatal deaths was more than four times as high, with 21 deaths among women with type 2 diabetes and 10 deaths among those with type 1.

Nearly half of babies born to women with type 1 diabetes were larger than their gestational age and this was also the case for nearly a quarter born to women with type 2 diabetes.

Delivery by caesarean section was common – involving 65% of babies born to women with type 1 diabetes and 57% of babies born to women with type 2.

The charity Diabetes UK said the findings suggested many women were not getting the support they needed.

Diabetes UK

Audit reveals gaps on pregnancy care for diabetes patients

Douglas Twenefour

Douglas Twenefour, its deputy head of care, said: “This audit reveals the unacceptable reality that, for too many women living with type 1 or type 2 diabetes, pregnancy remains fraught with unnecessary difficulties for both mother and baby.

“The clear reason for this is that women – for a number of reasons – are not getting the support they need before and during their pregnancies,” he said.

He highlighted that the report suggested that there were variations in the level of care and that many women were simply not aware of what they could do to protect themselves and their babies.

“We recommend that all women with diabetes receive individualised support to plan carefully for their pre-conception and pregnancy,” he said.

He noted that it was “vital for all women with diabetes” who discovered they were pregnant to make immediate contact with an antenatal team “in order to receive the best possible care”.

Mr Twenefour said urgent change was needed to ensure this happened across the board and called on health services to take action.

“The NICE recommendations on diabetes in pregnancy are clear, so today we’re calling on all services across public health, primary care, specialist diabetes and maternity to jointly take ownership of women’s health before and during pregnancy,” he said.

He added: “Without a joined-up approach, we will continue to see the harrowing results revealed by this audit.”

The Royal College of Midwives described the audit results as “troubling”.

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