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

More documents

Recommendations

Info

A comparison of type 1 and type 2 diabetes 11.3.3 Retinopathy in pregnancy Women with pre-existing diabetes are at risk of deterioration of existing retinopathy and development of new retinopathy during pregnancy. 3,4 In the enquiry, retinopathy was present in more women with type 1 diabetes than in type 2 diabetes (p
11.4 Preconception behaviour The CEMACH report on 3808 pregnancies in women with pre-existing diabetes found a poor level of pregnancy preparation, which was more marked for women with type 2 diabetes. 2 The enquiry module provided the opportunity to examine differences in other aspects of preconception behaviour. 11.4.1 Planned pregnancy and contraceptive use Planned pregnancy rates were similar for women with type 1 diabetes (60% of 121 women) and type 2 diabetes (62% of 84 women) (p=0.73, table 11.5), compared to a planned pregnancy rate of 58% in the UK in 2001-2002. 6 However, fewer women with type 2 diabetes had evidence of contraceptive use in the 12 months prior to pregnancy (p=0.001, table 11.5). This suggests that for women with type 2 diabetes, planning a pregnancy does not necessarily equate to the use of contraception when not actively trying to conceive. This may be linked to cultural beliefs and attitudes, and health professionals need to explore these issues during annual diabetes reviews and pre-pregnancy counselling. 11.4.2 Folic acid In the 2005 CEMACH report, 39% of all women were documented in the maternity notes or medical professional correspondence to have commenced folic acid before pregnancy, with fewer women with type 2 diabetes documented to have started folic acid in the preconception period. 2 For the enquiry module, general practitioners and the adult diabetes service were asked to provide information on folic acid use before pregnancy. A higher rate of preconception folic acid use than for the full cohort was reported (49% of women with type 1 diabetes and 45% of women with type 2 diabetes), and there was no observed difference between folic acid use in the two groups of women (p=0.60, Table 11.5). The difference in fi ndings between the descriptive study and the enquiry may be due to the fact that the information on folic acid in the descriptive study was dependent on documentation in the maternity notes, whereas in the enquiry, adult diabetes services and general practitioners were approached for information. It is also possible that health professionals were less likely to document folic acid use in the maternity notes or general medical records for women with type 2 diabetes than for women with type 1 diabetes, perhaps due to issues such as language diffi culties. Table 11.5 Preconception behaviour in women with pre-existing diabetes Women with type 1 diabetes n/N (%) Women with type 2 diabetes n/N (%) p-value Planned pregnancy 72/121 (60) 52/84 (62) 0.73 Evidence of contraceptive use in the 12 months prior to pregnancy 61/104 (59) 21/65 (32) 0.001 Evidence of preconception folic acid 54/110 (49) 32/71 (45) 0.60 Smoking 41/150 (27) 22/108 (20) 0.20 Assessment of suboptimal approach of the woman to managing her diabetes 83/135 (61) 51/88 (60) 0.60 before pregnancy Assessment of suboptimal approach of the woman to managing her diabetes during pregnancy 50/171 (29) 36/124 (29) 0.97 75
Page 1 and 2:
Confidential Enquiry into Maternal
Page 3 and 4:
Contents Acknowledgements .........
Page 5 and 6:
• Members of the CEMACH Diabetes
Page 7 and 8:
Erb’s palsy Injury to the nerve r
Page 9 and 10:
Neonatal unit A unit which provides
Page 11 and 12:
Foreword This third and fi nal repo
Page 13 and 14:
1. Introduction This is the fi nal
Page 15 and 16:
2. Key fi ndings of the CEMACH Diab
Page 17 and 18:
Suboptimal fetal surveillance of ba
Page 19 and 20:
3. Summary of recommendations This
Page 21 and 22:
2. Patient pathways of care includi
Page 23 and 24:
the pregnancies meeting this defi n
Page 25 and 26:
in order to remove any identifi abl
Page 27 and 28:
When deriving odds ratios for any p
Page 29 and 30:
Associations are reported in Chapte
Page 31 and 32:
Table 5.1 Characteristics of women
Page 33 and 34:
Table 5.4 Characteristics of women
Page 35 and 36: was no information available to pan
Page 37 and 38: 6. Factors associated with poor pre
Page 39 and 40: Table 6.2 Association of clinical c
Page 41 and 42: Table 6.5 Association of specifi c
Page 43 and 44: Table 6.8 Association of postnatal
Page 45 and 46: folic acid before pregnancy (19% of
Page 47 and 48: Table 7.2 Panel comments on social
Page 49 and 50: 7.5 Conclusions One of the key fi n
Page 51 and 52: 11.Dex S, Heather J (eds). Millenni
Page 53 and 54: 8. Clinical care issues: preconcept
Page 55 and 56: chance of induction of labour was r
Page 57 and 58: 8.6.1 Enquiry fi ndings Just over h
Page 59 and 60: Some quotes from the panel discussi
Page 61 and 62: Apart from the explanation of pregn
Page 63 and 64: was associated with poor pregnancy
Page 65 and 66: of women after the fi rst trimester
Page 67 and 68: 9.5.1 Panel comments on suboptimal
Page 69 and 70: During labour and delivery, the maj
Page 71 and 72: Just 52% of 383 women (38% of 164 c
Page 73 and 74: • ‘No serial growth scans perfo
Page 75 and 76: The panel enquiries, which are in e
Page 77 and 78: 10.3.1 Enquiry fi ndings Seventy fi
Page 79 and 80: 10.6 Communication Effective commun
Page 81 and 82: Some quotes from the panel discussi
Page 83 and 84: working between primary and seconda
Page 85: we therefore selected 7.2% of pregn
Page 89 and 90: enquiry related to a 12 month prior
Page 91 and 92: Table 11.10 Differences in postnata
Page 93 and 94: Type 1 and type 2 diabetes have tra
Page 95 and 96: Panels were chaired by the panel ch
Page 97 and 98: In 57% (24/42) of cases, a junior d
Page 99 and 100: Infant formula given as fi rst feed
Page 101 and 102: 2.1 hours in babies remaining with
Page 103 and 104: 12.7.1 Panel comments on suboptimal
Page 105 and 106: The concerns described here probabl
Page 107 and 108: External commentary Patricia Hamilt
Page 109 and 110: informed and motivated to manage th
Page 112 and 113: 100 Appendix A: Pre-pregnancy care
Page 114 and 115: 102 Appendix B: Diabetes enquiry pr
Page 132 and 133: Appendix C Association between demo
Page 134 and 135: Appendix C Association of preconcep
Page 136 and 137:
Appendix C Association of postnatal
Page 138 and 139:
Appendix D Association of social an
Page 140 and 141:
Appendix D Association of diabetes
Page 142 and 143:
Appendix E Association between demo
Page 144 and 145:
Appendix E Association between prec
Page 146 and 147:
Appendix E Association between post
Page 148 and 149:
Appendix F - CEMACH advisory groups
Page 150:
Appendix F - CEMACH advisory groups
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?