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

1. Introduction
This is the fi nal report of the Confi dential Enquiry into Maternal and Child Health (CEMACH) Diabetes
Programme, which commenced in 2002. The programme has focused on pregnancy in women with
type 1 and type 2 diabetes (with gestational diabetes excluded) and has included 3 modules:
1. A survey of diabetes maternity services for women with type 1 and type 2 diabetes in England,
Wales and Northern Ireland. 1
2. A descriptive study of 3808 pregnancies to women with type 1 and type 2 diabetes in England,
Wales and Northern Ireland who were identifi ed at any time between booking and delivery from
1 March 2002 to 28 February 2003, with follow up to pregnancy outcome at 28 days after delivery. 2
3. A national confi dential enquiry reviewing demographic, social and lifestyle factors, and clinical care
in 442 pregnancies to women with type 1 and type 2 diabetes, and their association with pregnancy
outcomes. The results of this last module are included within this report.
1.1 Context of the CEMACH Diabetes Programme
The topic of diabetes and pregnancy was chosen by CEMACH for a number of reasons:
• Diabetes is a common medical disorder complicating pregnancy, affecting 1 in 250 women
in England, Wales and Northern Ireland.
• In the mid-1990s, women with diabetes continued to have an increased risk of perinatal mortality,
stillbirth and poor pregnancy outcomes compared to the general maternity population 3-5 , despite
the St. Vincent’s Declaration in 1989 6 , which set a 5 year target for women with diabetes to achieve
similar pregnancy outcomes to women without diabetes.
• In 2001, the Diabetes National Service Framework (NSF) 7 , set out national standards for the
management of diabetes and pregnancy. The CEMACH Diabetes Programme offered the
opportunity to provide a national overview of maternity service provision and clinical care
for women with diabetes, which could be used to evaluate progress in implementation of the NSF.
1.2 Aims of the national enquiry
The aims of the enquiry module were:
• To investigate standards of care provided to women with type 1 and type 2 diabetes in England,
Wales and Northern Ireland and identify any underlying issues.
• To investigate any associations between poor pregnancy outcomes and demographic, social
and lifestyle, and clinical care factors.
• To investigate any associations between demographic and clinical characteristics, social
and lifestyle factors, and clinical care with type of diabetes.
1.3 A need for change
The prevalence of diabetes in the general population is increasing rapidly, due partly to an increasing
contribution from particular ethnic minority groups, and increasing obesity in the general population.
Type 2 diabetes is being diagnosed more frequently in younger age groups including children. 8 This is
likely to result in a continuing increase in the numbers of women with diabetes of childbearing age in
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