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

Table 11.10
Differences in postnatal care between women with type 1 and type 2 diabetes
Women with type 1
diabetes
n/N (%)
Women with type 2
diabetes
n/N (%)
p-value
No postnatal contraceptive advice 21/137 (15) 31/105 (30) 0.008
No written plan for post-delivery
diabetes management 20/156 (13) 15/115 (13) 0.95
Assessment of suboptimal
postnatal diabetes care 93/177 (53) 59/127 (46) 0.3
11.9 Conclusions
The comparison of women with type 1 and type 2 diabetes has shown some differences in clinical
characteristics (Body Mass Index, retinopathy and frequency and severity of hypoglycaemia in pregnancy)
which are to be expected from the difference in disease profi les between the two groups of women.
It is concerning that women with type 2 diabetes were less likely than women with type 1 diabetes to have
a retinal assessment in the fi rst trimester (or at booking if later), especially since retinopathy was a new
fi nding in fi ve out of the nine women with type 2 diabetes who had retinopathy in pregnancy. This may
refl ect a perception by health professionals that type 2 diabetes is less likely to cause complications than
type 1 diabetes, and highlights the importance of early and regular retinal assessment for all women with
pre-existing diabetes.
Before pregnancy, women with type 2 diabetes were less likely than women with type 1 diabetes to have a
retinal assessment or test for albuminuria in the 12 months before pregnancy. Women with type 2 diabetes
are more likely to be managed in primary care, and this fi nding may therefore refl ect a lack of awareness
by primary care professionals of the importance of screening for diabetes complications in women with
type 2 diabetes. There may also be diffi culties in accessing investigations such as retinal photographs that
are usually provided in the secondary care setting.
Women with type 2 diabetes were less likely to receive postnatal contraceptive advice. It is recognised that
health professionals may fi nd it diffi cult to provide contraceptive advice to women from different cultural
backgrounds due to language diffi culties and perceived cultural sensitivities. However, this is a vital aspect
of post-delivery counselling, and every effort should be made by health professionals to help women with
diabetes, including those with type 2 diabetes, to prepare adequately for future pregnancies.
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