Diabetes in pregnancy: are we providing the best care ... - HQIP
Diabetes in pregnancy: are we providing the best care ... - HQIP
Diabetes in pregnancy: are we providing the best care ... - HQIP
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enquiry related to a 12 month prior to <strong>pregnancy</strong> ra<strong>the</strong>r than 6 months as for <strong>the</strong> descriptive study. Also, <strong>in</strong><br />
<strong>the</strong> descriptive study, <strong>in</strong>formation was dependent on documentation <strong>in</strong> <strong>the</strong> maternity notes whereas <strong>in</strong> <strong>the</strong><br />
enquiry, <strong>the</strong> adult diabetes service and general practitioner <strong>we</strong>re also approached for <strong>in</strong>formation, and this<br />
may have resulted <strong>in</strong> <strong>in</strong>creased ascerta<strong>in</strong>ment.<br />
Women with type 1 diabetes <strong>we</strong>re more likely than women with type 2 diabetes to have suboptimal<br />
preconception glycaemic control as assessed by enquiry panels (table 11.7). This was similar to <strong>the</strong><br />
descriptive study, where only 24% of 1081 women with type 1 diabetes had a median HbA1c less than<br />
7% prior to <strong>pregnancy</strong> comp<strong>are</strong>d to 41% of 303 women with type 2 diabetes. 2<br />
Fe<strong>we</strong>r women with type 2 diabetes received <strong>in</strong>travenous <strong>in</strong>sul<strong>in</strong> and dextrose dur<strong>in</strong>g delivery (table 11.7).<br />
This fi nd<strong>in</strong>g may partly refl ect <strong>the</strong> fact that a proportion of women with type 2 diabetes do not require<br />
<strong>in</strong>sul<strong>in</strong> dur<strong>in</strong>g <strong>pregnancy</strong>. Also, women with type 2 diabetes <strong>we</strong>re more likely to be multiparous 2 , and <strong>the</strong>re<br />
may have been no opportunity <strong>in</strong> labour to commence <strong>in</strong>travenous <strong>in</strong>sul<strong>in</strong> and dextrose.<br />
Table 11.7<br />
Differences <strong>in</strong> factors related to glycaemic control bet<strong>we</strong>en women with type 1 and type 2 diabetes<br />
Women with type 1<br />
diabetes<br />
n/N (%)<br />
Women with type 2<br />
diabetes<br />
n/N (%)<br />
p-value<br />
No test of glycaemic control <strong>in</strong> <strong>the</strong> 12<br />
months prior to <strong>pregnancy</strong> 20/120 (17) 14/73 (19) 0.66<br />
No evidence of local targets set for<br />
glycaemic control 24/73 (33) 11/34 (32) 0.96<br />
Assessment of suboptimal<br />
preconception glycaemic control 105/140 (75) 58/97 (60) 0.013<br />
Assessment of suboptimal 1st<br />
trimester glycaemic control 104/160 (65) 66/122 (54) 0.064<br />
Assessment of suboptimal glycaemic<br />
control after 1st trimester 71/174 (41) 46/130 (35) 0.34<br />
Assessment of suboptimal blood<br />
glucose control dur<strong>in</strong>g labour and<br />
78/165 (47) 49/120 (41) 0.28<br />
delivery<br />
No <strong>in</strong>travenous <strong>in</strong>sul<strong>in</strong> and dextrose<br />
dur<strong>in</strong>g labour and/or delivery 18/180 (10) 38/133 (29)