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

chance of induction of labour was recorded as discussed with 42% of 380 women (32% of 193 cases
and 51% of 187 controls); and the possibility of caesarean delivery was recorded as discussed with 46%
of 381 women (39% of 194 cases and 53% of 187 controls). Women who did not have a discussion
about fetal risks and the possibility of caesarean delivery were more likely to have a poor pregnancy
outcome (OR 2.9, 95% CI 1.1, 8.2; and 2.4, 95% CI 1.0– 5.8 respectively, adjusted for maternal age
and deprivation, see Chapter 6). Additional case-control analysis (see Appendices C, D and E) showed
that the specifi c association was with fetal or neonatal death from 20 weeks gestation and not with fetal
congenital anomaly. Women who did not receive appropriate information about the risks and strategies of
management before pregnancy may have been less aware of the importance of optimal glycaemic control
and the need for careful diabetes management through pregnancy.
a
In this chapter, a case refers to a woman who had a poor pregnancy outcome, defi ned as a singleton
baby with a major congenital anomaly who delivered at any gestation and/or a baby who died from 20
weeks gestation up to 28 days after delivery.
b
In this chapter, a control refers to a woman who had a good pregnancy outcome, defi ned as a singleton
baby without a congenital anomaly who survived to day 28 after delivery.
8.4 Screening for diabetes complications
Pregnancy can cause deterioration of diabetes complications such as retinopathy and renal disease,
and screening for diabetes complications should be undertaken so that any necessary treatment can
be provided prior to pregnancy.
8.4.1 Enquiry fi ndings
In the year before pregnancy, only 59% of 382 women (54% of 196 cases and 64% of 186 controls) had
a retinal examination, and 58% of 382 women (53% of 195 cases and 63% of 187 controls) had a renal
function test (creatinine, electrolytes and urea). Women who did not have a retinal examination in the year
before pregnancy were more likely to have a poor pregnancy outcome (OR 2.3, 95% CI 1.2 - 4.5, adjusted
for maternal age and deprivation, see Chapter 6). In the additional case-control analysis (see Appendices
C, D and E) the specifi c association was with fetal or neonatal death from 20 weeks gestation and not
with fetal congenital anomaly. These women may have been less likely to access diabetes services before
pregnancy, either for cultural and societal reasons or due to inaccessible services; and may not have been
aware of the importance of pregnancy preparation and the risks of diabetic pregnancy.
8.5 Panel assessment of preconception care
The enquiry panels assessed that 73% of 267 women (87% of 133 cases and 60% of 134 controls) had
suboptimal preconception care. Women having suboptimal care were more likely to go on to have a poor
pregnancy outcome (OR 5.2, 95% CI 2.7 - 10.1, adjusted for maternal age and deprivation, see Chapter 6).
Additional case-control analysis (see Appendices C, D and E) showed an association with fetal congenital
anomaly but not with fetal or neonatal death from 20 weeks in babies without a congenital anomaly.
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