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

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
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