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

More documents

Recommendations

Info

Appendix C Association of postnatal care factors with major fetal congenital anomaly in the offspring of women with type 1 and type 2 diabetes Postnatal care factor Cases n/N (%) Controls n/N (%) Crude OR [95% CI] Adjusted OR a No postnatal contraceptive advice 39/83 (47) 26/163 (16) 4.7 [2.5, 3.9] 4.3 [2.3, 8.2] No written plan for post-delivery diabetes management 19/100 (19) 25/188 (13) 1.5 [0.8, 3.0] 1.8 [0.9, 3.5] Assessment of suboptimal postnatal diabetes care 72/116 (62) 106/211 (50) 1.6 [1.0, 2.6] 1.4 [0.9, 2.3] a Adjusted for maternal age and deprivation. 124
Appendix D Association of demographic and clinical characteristics, social and lifestyle factors, and clinical care with all fetal and neonatal deaths from 20 weeks of gestation up to 28 days after delivery in babies of women with type 1 and type 2 diabetes Association of demographic characteristics with fetal and neonatal death from 20 weeks gestation in babies of women with type 1 and type 2 diabetes Demographic characteristic Cases n/N (%) Controls n/N (%) Crude OR [95% CI] Adjusted OR Age - - 1.0 [1.0, 1.0] 1.0 [1.0, 1.0] b Black, Asian or Other Ethnic Minority group 35/137 (26) 41/220 (19) 1.5 [0.9, 2.5] 1.2 [0.7, 2.2] a Primigravidity 65/137 (47) 92/220 (42) 1.3 [0.8, 1.9] 1.4 [0.9, 2.3] a Maternal social deprivation d - - 1.2 [1.0, 1.4] 1.2 [1.0, 1.4] c a adjusted for maternal age and deprivation. b adjusted for maternal deprivation. c adjusted for maternal age. Odds ratio is for one year increase in maternal age. d Quintile of social deprivation derived from postcode of residence. Odds ratio is for unit increase in deprivation quintile. Association of clinical characteristics with fetal and neonatal death from 20 weeks gestation in babies of women with type 1 and type 2 diabetes Clinical characteristic Cases n/N (%) Controls n/N (%) Crude OR [95% CI] Adjusted OR a Body Mass Index (BMI ≥ 30) 22/81 (27) 33/137 (24) 1.2 [0.6, 2.2] 1.0 [0.5, 2.1] Pre-existing diabetes complications 25/115 (22) 16/197 (8) 3.1 [1.6, 6.3] 2.7 [1.3, 5.5] Retinopathy in pregnancy 32/89 (36) 50/167 (30) 1.3 [0.8, 2.3] 1.5 [0.8, 2.6] Diabetic nephropathy in pregnancy 17/108 (16) 14/185 (8) 2.3 [1.1, 4.9] 2.0 [0.9, 4.5] Recurrent episodes of hypoglycaemia during 62/125 (50) 105/205 (51) 0.9 [0.6, 1.5] 1.1 [0.7, 1.8] pregnancy Severe hypoglycaemia during pregnancy (one or more episodes of hypoglycaemia requiring external help) 16/90 (18) 32/167 (19) 0.9 [0.5, 1.8] 1.0 [0.5, 2.1] Antenatal evidence of fetal growth restriction Antenatal evidence of macrosomia (fetal size >90th centile) a adjusted for maternal age and deprivation. 14/113 (12) 11/218 (5) 2.7 [1.2, 6.1] 2.6 [1.1, 6.2] 34/109 (31) 76/216 (35) 0.8 [0.5, 1.4] 0.9 [0.6, 1.5] 125
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 and 10:
Neonatal unit A unit which provides
Page 11 and 12:
Foreword This third and fi nal repo
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
Page 61 and 62:
Apart from the explanation of pregn
Page 63 and 64:
was associated with poor pregnancy
Page 65 and 66:
of women after the fi rst trimester
Page 67 and 68:
9.5.1 Panel comments on suboptimal
Page 69 and 70:
During labour and delivery, the maj
Page 71 and 72:
Just 52% of 383 women (38% of 164 c
Page 73 and 74:
• ‘No serial growth scans perfo
Page 75 and 76:
The panel enquiries, which are in e
Page 77 and 78:
10.3.1 Enquiry fi ndings Seventy fi
Page 79 and 80:
10.6 Communication Effective commun
Page 81 and 82:
Some quotes from the panel discussi
Page 83 and 84:
working between primary and seconda
Page 85 and 86: we therefore selected 7.2% of pregn
Page 87 and 88: 11.4 Preconception behaviour The CE
Page 89 and 90: enquiry related to a 12 month prior
Page 91 and 92: Table 11.10 Differences in postnata
Page 93 and 94: Type 1 and type 2 diabetes have tra
Page 95 and 96: Panels were chaired by the panel ch
Page 97 and 98: In 57% (24/42) of cases, a junior d
Page 99 and 100: Infant formula given as fi rst feed
Page 101 and 102: 2.1 hours in babies remaining with
Page 103 and 104: 12.7.1 Panel comments on suboptimal
Page 105 and 106: The concerns described here probabl
Page 107 and 108: External commentary Patricia Hamilt
Page 109 and 110: informed and motivated to manage th
Page 112 and 113: 100 Appendix A: Pre-pregnancy care
Page 114 and 115: 102 Appendix B: Diabetes enquiry pr
Page 132 and 133: Appendix C Association between demo
Page 134 and 135: Appendix C Association of preconcep
Page 138 and 139: Appendix D Association of social an
Page 140 and 141: Appendix D Association of diabetes
Page 142 and 143: Appendix E Association between demo
Page 144 and 145: Appendix E Association between prec
Page 146 and 147: Appendix E Association between post
Page 148 and 149: Appendix F - CEMACH advisory groups
Page 150: Appendix F - CEMACH advisory groups
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?