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

Clinical care issues: preconception
8.5.1 Panel comments on suboptimal preconception care
Enquiry panels made 349 comments about preconception care. There were approximately equal numbers
of comments about clinical care issues and social and lifestyle issues. The social and lifestyle issues
identifi ed were identical to those described in Chapter 7, and are not reported again here. With respect
to clinical care issues, health professionals did not take the opportunity to give preconception advice,
including advice about contraception and folic acid, for 43% of women with suboptimal preconception care
(table 8.2). There were concerns about screening and management of diabetes complications for nearly a
tenth of the women.
Table 8.2
Panel comments on suboptimal preconception care in women with pre-existing diabetes (table contains information
following categorisation of free text)
Women assessed to have suboptimal preconception care
Good pregnancy outcome
(N=80)
No. of
comments
% of
women
Poor pregnancy outcome
(N=116)
No. of
comments
% of
women
Total comments* 51 88
Suboptimal clinical practice 47 - 74 -
Folic acid not advised or prescribed 16 20 21 18
Did not take opportunity to give
preconception advice 12 15 20 17
Poor screening or management
of diabetes complications 8 10 9 8
Contraception not advised 6 8 10 9
Suboptimal review of medication 1 1 8 7
Other 4 5 7 6
Communication between health
professionals or between health service
2 3 9 8
and woman
Miscellaneous 2 3 5 4
* There were 70 comments where the woman did not receive folic acid and 3 comments where she did not have preconception
care, where it was unclear as to whether this was a clinical care or social and lifestyle issue; these comments are not included in the
table. There were 137 comments on social and lifestyle issues, however these were identical to the themes underlying suboptimal
preconception glycaemic control (Chapter 7) and are not described further in this report.
8.6 Glycaemic control tests and targets
Regular testing of long term glycaemic control using glycosylated haemoglobin (HbA1c) is important in
order to inform the management of glycaemic control (Diabetes NSF 2001). 1 Targets for glycaemic control
should be set and discussed with women before pregnancy, so that they can take control of managing their
diabetes more effectively.
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