Diabetes in pregnancy: are we providing the best care ... - HQIP
Diabetes in pregnancy: are we providing the best care ... - HQIP Diabetes in pregnancy: are we providing the best care ... - HQIP
Glossary and abbreviations Stillbirth Legal defi nition: a child that has issued forth from its mother after the 24th week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life (Section 41 of the Births and Deaths Registration Act 1953 as amended by the Stillbirth Defi nition Act 1992) Stillbirth rate The number of stillbirths per 1000 total births (live births and stillbirths) Termination of See Legal abortion pregnancy Thrombosis The formation or presence of a clot of coagulated blood in a blood vessel Thyroxine An iodine-containing hormone produced by the thyroid gland Transitional care unit A unit providing care of term or near-term babies not needed high-dependency or intensive care, which can be safely delivered without babies being separated from their mothers Trimester One of the 3-month periods into which pregnancy is divided. The fi rst trimester is 0-13 weeks of gestation, the second trimester is 14-26 weeks of gestation, and the third trimester is 27 weeks of gestation until birth. Type 1 diabetes There is an absolute defi ciency of insulin production, due to autoimmune destruction of the insulin-producing beta cells in the islets of Langerhans in the pancreas. It accounts for 5 – 15% of all people with diabetes. Type 2 diabetes There is a relative defi ciency of insulin production, and/or the insulin produced is not effective (insulin resistance). It accounts for 85% - 95% of all people with diabetes. UK United Kingdom USS Ultrasound scan x
Foreword This third and fi nal report of the CEMACH national diabetes programme comes at an important time in the national drive to improve services for women with diabetes in pregnancy. The National Service Framework (NSF) for Diabetes requires the NHS to develop, implement and monitor policies that seek to empower and support women with diabetes to optimise the outcomes of their pregnancy. The CEMACH report shows that, whilst progress has been made in improving services for women with diabetes and their babies, there is much still to be done to meet the standards recommended by the NSF. Too many women continue to be poorly prepared for pregnancy in the critical areas of glycaemic control and folic acid supplementation. The report underlines the need for an increased focus on diabetes preconception care services and the development of strategies to educate women with diabetes of childbearing age. The growing proportion of women with type 2 diabetes during pregnancy, many of whom are from minority ethnic groups, presents an additional challenge for health services in developing responsive and accessible services. This CEMACH report has identifi ed several areas of good clinical practice during pregnancy in women with pre-existing diabetes. However, there continue to be areas where there is room for improvement, including antenatal fetal surveillance, glycaemic control during labour and delivery and postnatal diabetes care. The National Institute for Health and Clinical Excellence (NICE) is currently in the fi nal stages of development of its new guideline for the management of diabetes in pregnancy. This guideline, when taken together with the CEMACH report, will provide local health services with an unprecedented wealth of material on which to base their development of improved services for women with diabetes in pregnancy. Sir Liam Donaldson Chief Medical Officer Department of Health, England xi
- Page 1 and 2: Confidential Enquiry into Maternal
- Page 3 and 4: Contents Acknowledgements .........
- Page 5 and 6: • Members of the CEMACH Diabetes
- Page 7 and 8: Erb’s palsy Injury to the nerve r
- Page 9: Neonatal unit A unit which provides
- Page 13 and 14: 1. Introduction This is the fi nal
- Page 15 and 16: 2. Key fi ndings of the CEMACH Diab
- Page 17 and 18: Suboptimal fetal surveillance of ba
- Page 19 and 20: 3. Summary of recommendations This
- Page 21 and 22: 2. Patient pathways of care includi
- Page 23 and 24: the pregnancies meeting this defi n
- Page 25 and 26: in order to remove any identifi abl
- Page 27 and 28: When deriving odds ratios for any p
- Page 29 and 30: Associations are reported in Chapte
- Page 31 and 32: Table 5.1 Characteristics of women
- Page 33 and 34: Table 5.4 Characteristics of women
- Page 35 and 36: was no information available to pan
- Page 37 and 38: 6. Factors associated with poor pre
- Page 39 and 40: Table 6.2 Association of clinical c
- Page 41 and 42: Table 6.5 Association of specifi c
- Page 43 and 44: Table 6.8 Association of postnatal
- Page 45 and 46: folic acid before pregnancy (19% of
- Page 47 and 48: Table 7.2 Panel comments on social
- Page 49 and 50: 7.5 Conclusions One of the key fi n
- Page 51 and 52: 11.Dex S, Heather J (eds). Millenni
- Page 53 and 54: 8. Clinical care issues: preconcept
- Page 55 and 56: chance of induction of labour was r
- Page 57 and 58: 8.6.1 Enquiry fi ndings Just over h
- Page 59 and 60: Some quotes from the panel discussi
Foreword<br />
This third and fi nal report of <strong>the</strong> CEMACH national diabetes programme comes at an important time <strong>in</strong> <strong>the</strong><br />
national drive to improve services for women with diabetes <strong>in</strong> <strong>pregnancy</strong>. The National Service Framework<br />
(NSF) for <strong>Diabetes</strong> requires <strong>the</strong> NHS to develop, implement and monitor policies that seek to empo<strong>we</strong>r and<br />
support women with diabetes to optimise <strong>the</strong> outcomes of <strong>the</strong>ir <strong>pregnancy</strong>. The CEMACH report shows<br />
that, whilst progress has been made <strong>in</strong> improv<strong>in</strong>g services for women with diabetes and <strong>the</strong>ir babies, <strong>the</strong>re<br />
is much still to be done to meet <strong>the</strong> standards recommended by <strong>the</strong> NSF. Too many women cont<strong>in</strong>ue to<br />
be poorly prep<strong>are</strong>d for <strong>pregnancy</strong> <strong>in</strong> <strong>the</strong> critical <strong>are</strong>as of glycaemic control and folic acid supplementation.<br />
The report underl<strong>in</strong>es <strong>the</strong> need for an <strong>in</strong>creased focus on diabetes preconception c<strong>are</strong> services and <strong>the</strong><br />
development of strategies to educate women with diabetes of childbear<strong>in</strong>g age. The grow<strong>in</strong>g proportion<br />
of women with type 2 diabetes dur<strong>in</strong>g <strong>pregnancy</strong>, many of whom <strong>are</strong> from m<strong>in</strong>ority ethnic groups, presents<br />
an additional challenge for health services <strong>in</strong> develop<strong>in</strong>g responsive and accessible services.<br />
This CEMACH report has identifi ed several <strong>are</strong>as of good cl<strong>in</strong>ical practice dur<strong>in</strong>g <strong>pregnancy</strong> <strong>in</strong> women<br />
with pre-exist<strong>in</strong>g diabetes. Ho<strong>we</strong>ver, <strong>the</strong>re cont<strong>in</strong>ue to be <strong>are</strong>as where <strong>the</strong>re is room for improvement,<br />
<strong>in</strong>clud<strong>in</strong>g antenatal fetal surveillance, glycaemic control dur<strong>in</strong>g labour and delivery and postnatal diabetes<br />
c<strong>are</strong>. The National Institute for Health and Cl<strong>in</strong>ical Excellence (NICE) is currently <strong>in</strong> <strong>the</strong> fi nal stages of<br />
development of its new guidel<strong>in</strong>e for <strong>the</strong> management of diabetes <strong>in</strong> <strong>pregnancy</strong>. This guidel<strong>in</strong>e, when<br />
taken toge<strong>the</strong>r with <strong>the</strong> CEMACH report, will provide local health services with an unprecedented<br />
<strong>we</strong>alth of material on which to base <strong>the</strong>ir development of improved services for women with diabetes<br />
<strong>in</strong> <strong>pregnancy</strong>.<br />
Sir Liam Donaldson<br />
Chief Medical Officer<br />
Department of Health, England<br />
xi
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