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

Clinical care issues: preconception
Table 8.3
Panel comments about clinical care issues related to suboptimal preconception glycaemic control (table contains
information following categorisation of free text)
Women assessed to have suboptimal
preconception glycaemic control
Good pregnancy outcome
(N=115)
Poor pregnancy outcome
(N=165)
No. of comments % of women No. of comments % of women
Total comments* † 20 28
Suboptimal clinical practice 15 13 11 7
Suboptimal communication 5 4 16 10
Miscellaneous 0 0 1 1
* There were 81 comments where the issues were not described by panels and 18 comments where there was a lack of
preconception care with the reason being unclear to panels; these comments are not included in this table.
† 187 comments were made on social and lifestyle issues; these are described in Chapter 7.
8.8 Conclusions
Prior to pregnancy, clinical support and information for women appeared to be poor:
• Just over half of women had a retinal examination and a renal function test in the 12 months before
pregnancy.
• Only a quarter of women had evidence of glycaemic control targets being set and just over half
had documented evidence of a discussion about glycaemic control in the 12 months prior to
pregnancy.
• Less than half of women had documented evidence that diet, contraception, or diabetes
complications had been discussed in the 12 months before pregnancy.
• Less than half of women were documented to be informed about fetal risks, the increased chance
of induction of labour and the possibility of caesarean delivery.
• Documentation of pre-pregnancy counselling was poor.
Enquiry panels found that health professionals often missed the opportunity to provide pre-pregnancy
counselling, and did not appear to advise about or prescribe folic acid or contraception before pregnancy.
There were also concerns about a lack of timely input by the diabetes team and whether insulin regimes in
the preconception period were appropriate to achieve tight glycaemic control.
These fi ndings suggest that the majority of women with diabetes are not having effective annual diabetes
reviews, and that the maternity component of preconception care (contraception, folic acid, information
about the impact of diabetes on pregnancy) is missing for many women.
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