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

Key fi ndings of the CEMACH Diabetes Programme
2.4 Preconception care
In the CEMACH survey of maternity services, less than a fi fth of maternity units in England, Wales and
Northern Ireland provided structured multidisciplinary preconception care for women with diabetes. 5
Women with diabetes were poorly prepared for pregnancy:
• Less than half were recorded to take folic acid supplements prior to pregnancy
• Less than half were recorded to have had preconception counselling regarding glycaemic control,
diet, contraception, diabetes complications and alcohol intake
• A third were recorded to have a test of glycaemic control in the 6 months before pregnancy 1
• Two-thirds had evidence of suboptimal glycaemic control before conception and in the fi rst
trimester of pregnancy.
Suboptimal preconception care, glycaemic control before and during pregnancy and approach of the
woman to managing her diabetes were all associated with poor pregnancy outcome.
One of the main underlying factors to suboptimal preconception care was failure of provision of appropriate
care by health professionals: preconception counselling, contraceptive advice, provision of high dose folic
acid, and appropriate screening and management of diabetes complications.
The main factors underlying suboptimal glycaemic control and a suboptimal approach to managing
diabetes were social and lifestyle issues: non-attendance of women at planned appointments, nonadherence
to medical advice about diabetes management, unplanned pregnancy and social factors
including language diffi culties, diffi cult domestic circumstances and erratic or busy lifestyles.
Only a minority of women in the enquiry appeared to be using any form of contraception in the 12 months
before pregnancy, based on documentation by adult diabetes services and primary care. This suggests
that women are not aware of the importance of continuing effective contraception until their glycaemic
control is as near-normal as possible.
In the enquiry, a minority of women were documented to be on high dose (5mg) folic acid
before pregnancy.
There was poor documentation of preconception care and advice given.
2.5 Clinical care during pregnancy
Suboptimal maternity care during pregnancy was associated with poor pregnancy outcome. Underlying
issues identifi ed included suboptimal fetal surveillance (both cardiotocograph and ultrasound monitoring)
and poor management of maternal risks identifi ed during the course of pregnancy.
Suboptimal diabetes care (excluding glycaemic control) during pregnancy was associated with poor
pregnancy outcome.
4