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

11. A comparison of type 1 and type 2 diabetes
Learning points
• Women with type 2 diabetes in pregnancy were more likely to be obese compared to women
with type 1 diabetes.
• Planned pregnancy rates were similar for women with type 1 and type 2 diabetes but women
with type 2 diabetes were less likely to have evidence of contraceptive use in the 12 months
before pregnancy.
• Women with type 2 diabetes were less likely than women with type 1 diabetes to have had
a retinal assessment or test for albuminuria in the 12 months before pregnancy.
• Women with type 1 diabetes in pregnancy were more likely to have retinopathy, recurrent
hypoglycaemia and severe hypoglycaemic episodes than women with type 2 diabetes.
Nevertheless, a fi fth of women with type 2 diabetes had recurrent hypoglycaemia and
5% had new retinopathy in pregnancy.
• Women with type 2 diabetes were less likely than women with type 1 diabetes to have
a retinal assessment in the fi rst trimester of pregnancy and less likely to receive postnatal
contraceptive advice.
11.1 Introduction
The prevalence of type 2 diabetes is increasing 1 and the CEMACH report on 3808 pregnancies in women
with pre-existing diabetes in England, Wales and Northern Ireland found that more than a quarter (27%)
of women with pre-existing diabetes had type 2 diabetes. 2 Women with type 2 diabetes were a very
different group to women with type 1 diabetes being more likely to be older, multiparous, from a Black,
Asian and Other ethnic minority group and resident in an area of social deprivation. 2 Women with
type 2 diabetes were also less likely to have had pre-pregnancy counselling, preconception folic acid
and a test of glycaemic control in the 6 months before pregnancy. 2
The enquiry module of the CEMACH Diabetes programme therefore set out to provide additional
information about the differences between women with type 1 and type 2 diabetes, in terms of clinical
characteristics, social and lifestyle issues, and the care provided to women.
11.2 Methodology
All women selected for the main enquiry as the control group (n=220) were included in the analyses for this
chapter. In addition, 79 extra type 2 diabetic pregnancies resulting in a good outcome were also included
(see Chapter 4). This gave a total of 170 women with type 1 diabetes and 127 women with type 2 diabetes,
which represented 7.2% and 14.4% of all women with type 1 diabetes and type 2 diabetes respectively
having a good pregnancy outcome in the full descriptive study population of 3808 pregnancies. In order
to analyse a representative sample of women with type 1 and type 2 diabetes from the descriptive study,
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