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

Apart from the explanation of pregnancy risks and the need to maintain good glycaemic control, some
drugs which may be prescribed for women with type 2 diabetes, such as ACE inhibitors, are harmful in
pregnancy. This emphasis on informing women of the risks and the preventive actions they can take,
means that diabetes services for women of child bearing age should be planned in a slightly different way
to other diabetes services. This is supported by the recently developed diabetes workforce competencies c
that specifi cally address the needs of women of child bearing age with diabetes, as well as those actively
seeking to become pregnant, and those who are already pregnant.
The current absence of structured preconception care needs to be set within the context of the increasing
number of women of child bearing age with diabetes – mainly type 2 diabetes. This rise has been fuelled
by a number of factors, including the increasing obesity of the general population, changing ethnic
demographics and reducing levels of exercise and fi tness. An additional factor is that women from ethnic
minority groups with an increased risk of type 2 diabetes, tend to have larger families. The General
Household Survey 1988-2001 d found that women of Bangladeshi origin tended on average to have
families twice as large as the White population.
The Diabetes National Service Framework (NSF) recommends that all diabetes services should be
effectively planned, but it is clear that this is currently not the case for the majority of local services across
the country, either for routine or preconception care. While pregnancy in women with diabetes used to be
considered a specialist activity, there is now a critical need for services to be planned jointly in primary
as well as secondary care in order to achieve integrated models of preconception and pregnancy care.
This is an immense challenge, and diabetes networks have a crucial role in supporting this planning and
commissioning process by enabling each of the stakeholders to identify needs and priorities.
Although it may be diffi cult to accept, we must understand that pregnancy for women with diabetes will
always be high risk. However, it is our responsibility to discover new ways of working with women that
will reduce the risks and ensure the best possible outcomes, both for them and their babies.
c
Skills for Health, Diabetes Workforce Competencies, 2006.
d
Sources: Census 2001, Offi ce for National Statistics; General Register Offi ce for Scotland.
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