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

Clinical governance
4. In order to raise awareness, it is recommended that the specialist multidisciplinary team should
provide regular educational days for all primary and secondary care professionals likely to
be involved in the care of women with diabetes in the local population, to cover all aspects of
preconception, pregnancy and postnatal care.
Audit and research
5. Diabetes networks should carry out regular audits of preconception and pregnancy services.
References
1. National Service Framework for Diabetes (England) Standards. Department of Health.
The Stationery Offi ce: London: 2001.
2. Confi dential Enquiry into Maternal and Child Health. Survey of maternity services for women
with type 1 and type 2 diabetes in 2002-03, England, Wales and Northern Ireland. CEMACH:
London; 2004.
3. Jardine Brown C, Dawson A, Dodds R, Gamsu H, Gillmer M, Hall M, et al. Report of the
Pregnancy and Neonatal Care Group. Diabetic Med 1996;13:S43-S53.
4. Clinical Negligence Scheme for Trusts Maternity Clinical Risk Management Standards.
NHS Litigation Authority. April 2006.
Commentary
John Scarpello
Deputy Medical Director, National Patient Safety Agency
Consultant Diabetes Physician, University Hospital of North Staffordshire
The CEMACH Diabetes Programme has raised important issues for those providing maternity services
for women with diabetes. The CEMACH survey of diabetes maternity services showed an encouraging
increase in the support available to women and most of the trusts surveyed had established combined
multidisciplinary clinics. However, despite these developments, areas of unsatisfactory practice remain. All
members of the multidisciplinary team were only involved in 22% of women in the enquiry and, surprisingly,
dietitians were often absent. Dietetic support is important for both maternal and fetal nutrition but is also
especially valuable in optimising glycaemic control, which is vital to a successful outcome.
Women with type 1 and type 2 diabetes require careful pre-pregnancy assessment with excellent
glycaemic control and folic acid supplementation before conception. Once pregnancy is confi rmed prompt
referral is required to the multidisciplinary diabetes and obstetric team. The present enquiry has shown
several areas where management is suboptimal. These include little evidence of pre-pregnancy planning
and a lack of antenatal care guidelines.
Diabetes management is now more often provided by primary care rather than the secondary care
specialist diabetes service. Whilst there may be advantages to this model for many people with diabetes,
the management of women with diabetes of childbearing age demands agreed patient pathways and joint
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