Diabetes in pregnancy: are we providing the best care ... - HQIP

13. Conclusions
The St. Vincent declaration in 1989 1 that ‘in fi ve years, the outcome of diabetic pregnancy should
approximate that of non-diabetic pregnancy’, has not yet been achieved. However, there have been a
number of national and local initiatives focusing on improving the care and outcomes of pregnant women
with type 1 and type 2 diabetes.
The Diabetes National Service Framework 2 , fi rst published by the Department of Health in 2001, set out
a series of national standards for the care of people with diabetes. This included a standard for pregnancy
which emphasised the importance of tight blood glucose control before conception and during pregnancy
in order to optimise the chance of a good pregnancy outcome. The NSF includes key interventions,
targets and illustrative service models which are available for NHS organisations to draw upon during the
development of their local services, and local NHS performance will be assessed against the three-year
and ten-year targets in the NSF’s Delivery Strategy. 3 In addition, the Diabetes Commissioning Toolkit 4
published by the Department of Health in November 2006 includes best practice quality markers, evidence
of improvement, and key outcomes that should be sought by commissioners of services. In particular, it
specifi es that there should be evidence of defi ned leadership within specialist services and integration
between primary and secondary care for pre-pregnancy care and support.
The CEMACH Diabetes Programme has provided a comprehensive national overview of diabetes
maternity services, standards of care for women with diabetes, and the possible reasons underlying
suboptimal clinical care and lack of involvement of women in their own care. This should aid health
care providers and commissioners in planning the most appropriate services for their local populations.
The programme has highlighted a number of areas which need to be addressed. These include poor
preparation for pregnancy and the need for effective education programmes for women of childbearing
age with diabetes; fragmented preconception care services and variations in the standard of preconception
care provided by health professionals; the increasing problem of women with type 2 diabetes and their
different needs; and neonatal care policies.
As a response to the fi nding that the majority of women with diabetes are poorly prepared for pregnancy,
CEMACH, together with the Royal College of General Practitioners and Diabetes UK, has published a joint
information leafl et for GPs and the primary care team. This sets out information about the appropriate care
and advice to provide for women of childbearing age with diabetes. The leafl et has been distributed to GPs
throughout the UK and is also available for downloading from the CEMACH website.
Poor preparation for pregnancy appears to be the next barrier to overcome for women with diabetes. The
CEMACH programme has found that pregnant women with type 2 diabetes, who are also more likely to be
from a Black, Asian and Other ethnic minority group and live in a deprived area, appear to be less likely
to access preconception care and annual diabetes reviews than women with type 1 diabetes. In order to
better understand the reasons and possible solutions to this, CEMACH has commenced a research project
with the University College London (UCL) Elizabeth Garrett Anderson Institute for Women’s Health which is
funded by Novo Nordisk. This will investigate the issues affecting preconception care in women with type 1
and type 2 diabetes.
It is clear that commissioners and providers of health care in both primary and secondary care settings
need to work collaboratively. Their joint aim should be to ensure that women with diabetes are better
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