EASIPOD - East Anglian Study for Improving Pregnancy Outcomes in women with Diabetes (updated in April 08)
25 September 2006
Intended Audience
Women with Diabetes and Health care professionals in primary and secondary care
Health Area
10 regional centres across East Anglia including Ipswich, Cambridge, Norwich, Peterborough, Bedford, Luton, Kings Lynn, Great Yarmouth, Bury St Edmunds, Hinchingbrooke and their relevant PCTs
Background
Pregnancy outcomes in women with diabetes remain poor across the UK with increased risks in women with type 2 diabetes identified across East Anglia
How this service improves
The risk factors we identified for poor pregnancy outcomes in East Anglia are potentially modifiable i.e poor pregnancy planning, lack of folic acid, late presentation and concomitant medications taken by women with type 2 diabetes. We are identifying women of reproductive years (aged 16-45) so that they can be provided with appropriate information regarding their risks and more importantly how to prevent them
( The risk rates mentioned in the leaflet are taken from an article in Diabetes Care vol 29 (8) 2006 on Prepregnancy care and pregnancy outcomes in women with type 1 diabetes.)
Why this service is a good example of shared practice
This service provides information directly to women so that they may make informed choices regarding planning a pregnancy. It is, to our knowledge, the first time that women at risk of poor pregnancy outcome have been systematically identified and provided with an honestly optimistic theoretically guided patient information leaflet. This leaflet was developed by women with diabetes with normal and poor pregnancy outcomes, theoreticaly guided by an independent team of psychologists and formally tested in groups of women of reproductive ages and was well received in these groups. Funding for it's development was provided by Diabetes UK and it is now available for sharing in primary and secondary care throughout the region.
Objectives
We aim to provide written information regarding diabetes and pregnancy to all women with diabetes between the ages of 16-45 years in East Anglia. By promoting increased awareness of prepregnancy care in women with diabetes as well as health professionals we aim to increase attendance rates at prepregnancy care clinics across the region. This we hope will improve preparation for pregnancy and lead to better pregnancy outcomes for women with diabetes
Service Provided
A regional prepregnancy care (PPC) service co-ordinator has been appointed for 3 years. She will be responsible for co-ordinating awareness of prepregnancy care between health professionals and women with diabetes. She will ensure that all women identified receive the information leaflet which has been developed. The impact of this promotion on prepregnancy care clinic attendance and pregnancy outcomes will be formally evaluated over 3 years.
The PPC co-ordinator is an ex diabetes specialist midwife recruited back from a community matron position in primary care. This gives her the important links between secondary and primary care and helps us get the information regarding PPC promotion across to practice managers, practice nurses and GPs. The co-ordinator is writing to each practice asking them to identify all women aged 14-45 years with diabetes on their practice databases so that the EASIPOD patient information leaflet can be sent to them either directly or via the practice nurse. Women in secondary care will be identified through the hospital or retinal screening databases.
The co-ordinator is liaising with the primary care information management teams to make the leaflet available electronically across the main IT networks so that when a female aged 16-45 is seen by their GP or practice nurse , a screen message will pop up to prompt them to ask about contraception, future pregnancy and other related subjects, with a link to the information leaflet. This was strongly recommended during consultation with GPs and practice nurses. The co-ordinator is also working with pharmacy health promotion teams so that they can also access the leaflet and be aware of the risks regarding medications including ACE and statins to women of reproductive ages.
Accountability
This project has been funded by Diabetes UK and approved by local research governance and ethics committees, to whom it will report annually.
Project Aims
The aims are to increase attendance at prepregnancy care clinics, improve preparation for pregnancy, improve pregnancy outcomes and interview women who do not attend so that the current services can be made more relevant to a wider range of women in the future.
Evaluation
To date a theoretically guided, independently tested patient information leaflet has been developed and will be made available to health professionals in primary and secondary care as well as women with diabetes
Resources
Diabetes UK has awarded a 3 year project grant which allows us to promote, develop and evaluate prepregnancy care across the region
Learning
From this project we will learn whether systematic promotion of prepregnancy care to women and health professionals will increase attendance, improve pregnancy preparation and reduce the risks of adverse pregnancy outcomes
Additional Information
By interviewing women who do not attend we will learn more about the views, attitudes, and beliefs of this group for who we need to do more if they are to be actively engaged in attending prepregnancy care services in the future