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

Clinical care issues: pregnancy
Table 9.3
Panel comments on suboptimal diabetes care (excluding glycaemic control) in pregnancy (table contains information
following categorisation of free text)
Women assessed to have suboptimal diabetes care in pregnancy
Good pregnancy outcome
n=118
Poor pregnancy outcome
n=146
No. of comments % of women No. of comments % of women
Total comments* 174 - 224 -
Suboptimal clinical practice 159 196
Lack of /suboptimal retinal screening/
management 72 61 71 49
Suboptimal renal function monitoring/
management 38 32 49 34
Lack of multidisciplinary involvement 25 21 31 21
Lack of senior input 2 2 7 5
Poor management of glycaemic control
during steroid administration 1 1 1 1
Suboptimal management of
pre-pregnancy medication 0 0 2 1
Suboptimal management of other
complications e.g. proteinuria +/-BP,
6 5 12 8
ketonuria
Infrequent clinic appointments 2 2 9 6
Other 13 11 14 10
Communication issues 5 4 9 6
Patient factors 10 8 19 13
* 34 comments were about social and lifestyle issues.
9.5 Antenatal fetal surveillance
Careful fetal surveillance is important in diabetic pregnancy, including serial ultrasound scans for fetal
growth during the third trimester and consideration of cardiotocograph monitoring from 36 weeks. 7 Enquiry
panels assessed that fetal surveillance was suboptimal for 20% of 37 babies with antenatal evidence of
fetal growth restriction and for 45% of 129 babies with antenatal evidence of macrosomia (defi ned for
panel enquiries as fetal size >90th centile). For babies with antenatal evidence of macrosomia, suboptimal
fetal surveillance was associated with poor pregnancy outcome (OR 5.3, 95% CI 2.4 -12.0, adjusted for
maternal age and deprivation, see Chapter 6). Additional case-control analysis (see Appendices C, D
and E) showed an association with fetal or neonatal death after 20 weeks gestation and not with fetal
congenital anomaly.
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