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

Just 52% of 383 women (38% of 164 cases and 63% of 219 controls) were documented to have had
contraceptive advice provided before discharge from hospital. Women who had had a poor pregnancy
outcome were more likely not to receive contraceptive advice than women with a good pregnancy
outcome (OR 4.2, 95% CI 2.4 - 7.4, adjusted for maternal age and deprivation, see Chapter 6)
Enquiry panels assessed that 57% of 364 women (66% of 153 cases and 50% of 211 controls) delivering
after 24 weeks gestation had suboptimal postnatal diabetes care and advice. Women who had a poor
pregnancy outcome were more likely to have suboptimal postnatal diabetes care (adjusted OR 1.8, 95%
CI 1.2 - 2.7, adjusted for maternal age and deprivation, see Chapter 6).
9.9.2 Panel comments on suboptimal postnatal diabetes care
Panels made 267 comments for 207 women, with the majority of these being related to suboptimal clinical
care. Concerns included management of glycaemic control after delivery, inadequate plans of care at
discharge from hospital, lack of contact with the diabetes team and no contraceptive advice given to
women (table 9.8).
Table 9.8
Panel comments about suboptimal postnatal diabetes care (table contains information following categorisation
of free text)
Women assessed to have suboptimal postnatal diabetes care
Good pregnancy outcome
(N=106)
No. of comments % of women No. of
comments
Poor pregnancy outcome
(N=101)
% of women
Total comments* 95 129
Suboptimal clinical practice 95 - 129 -
Suboptimal management of glycaemic control 40 38 31 31
Inadequate plan of care at discharge 24 23 36 36
Lack of contact with diabetes team 15 14 30 30
No contraceptive advice 14 13 29 29
Other 2 2 3 3
* There were 32 comments where the underlying issues were not described by panels, and 11 comments about social and lifestyle
issues; these comments are not included in this table.
9.10 Conclusions
It is encouraging that there were a number of areas of good practice identifi ed:
• 78% of women were monitored for nephropathy
• 79% of women had evidence of glycaemic control targets for labour and delivery
• 68% of women receiving antenatal steroids had an insulin and dextrose infusion commenced
• 86% of women had a documented discussion about timing and mode of delivery
• 65% of women had optimal maternity care during labour and delivery
• 81% of women had a written plan for post-delivery diabetes management.
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