Diabetes UK is calling for an urgent, joined-up approach to drastically improving preconception, maternity and antenatal services for women living with diabetes following the publication of a new audit.
- Stillbirth rates more than twice those of general population, and neonatal deaths more than four times, audit reveals.
- Only 1 in 12 women achieving all three key recommended pre-pregnancy health measures.
- Nearly half of babies born to women with Type 1 diabetes, and nearly a quarter born to women with Type 2 diabetes, were larger than gestational age (LGA).
National Pregnancy in Diabetes Audit
The National Pregnancy in Diabetes Audit 2016, published on 12 October by NHS Digital and supported by the charity, revealed that for too many women living with diabetes, pregnancy still comes with too many practical difficulties for both mother and baby, suggesting that services are failing to provide these women with the essential support they need before and during pregnancy.
The audit looked at 3,356 pregnancies in 3,297 women across 172 antenatal diabetes services. Of these women, 1,608 had Type 2 diabetes.
A key issue highlighted by the report was that few women living with diabetes are well prepared for pregnancy. To support a healthy pregnancy, it is recommended that women:
- keep control of their blood sugar, aiming for a safe HbA1c level of below 48mmol/mol
- take a high-dose supplement of folic acid (5mg a day)
- review any medication they’re taking to ensure it’s safe during pregnancy.
However, the audit revealed that only 1 in 12 women (8%) were achieving this.
The audit revealed that for women living with diabetes, stillbirths were more than twice as high, and neonatal deaths more than four times as high, as among the general population. Women living with Type 2 diabetes experienced more neonatal deaths overall – with 21 deaths – compared to 10 deaths experienced by women living Type 1 diabetes.
Douglas Twenefour, Diabetes UK’s Deputy Head of Care, said:
“This audit reveals the unacceptable reality that, for too many women living with Type 1 or Type 2 diabetes, pregnancy remains fraught with unnecessary difficulties for both mother and baby. The clear reason for this is that women – for a number of reasons – are not getting the support they need before and during their pregnancies.
“Diabetes UK wants to see urgent action on this issue. The steps women can take before getting pregnant are clear, but the audit suggests there are still variations in the level of care across services and that far too many of them are simply not aware of what they can do to protect themselves and their babies.
“We recommend that all women with diabetes receive individualised support to plan carefully for their preconception and pregnancy. It is vital for all women with diabetes who discover they are pregnant to make immediate contact with an antenatal team in order to receive the best possible care. Women with unplanned pregnancies will be particularly in urgent need of this immediate care and support, as they may be taking medications that could potentially harm their unborn baby.
“The NICE recommendations on diabetes in pregnancy are clear, so today we’re calling on all services across public health, primary care, specialist diabetes and maternity to jointly take ownership of women’s health before and during pregnancy. Without a joined-up approach, we will continue to see the harrowing results revealed by this audit. Things need to change, and urgently.”
As women with Type 2 diabetes are more likely to be black, Asian or mixed race, Diabetes UK is also calling for further work to be done to improve awareness of pre-pregnancy care among BAME communities.
Most women living with diabetes who may become pregnant have regular contact with their GP, a crucial opportunity to make these women, and the clinicians that support them, aware of the steps they should take for a healthier pregnancy. To support this, Diabetes UK has developed and rolled out the Pregnancy Information Prescription – a tool to help healthcare professionals to discuss pregnancy preparations with all women living with diabetes who may become pregnant, and to agree personal action plans to ensure a safe and healthy pregnancy.
Sarah's control of her diabetes wasn't as good as it should've been when she started trying for a baby. Although she was seeing her GP for check-ups, she wasn't fully aware of the risks and was pregnant before she realised how serious it could be.
“I then read up on what effects diabetes can have on pregnancy and I felt quite irresponsible for not having taken better care of my sugar levels before. I wanted this baby so much but was really worried that I would have a miscarriage. My pregnancy was without doubt the hardest thing I've ever done, but worth every minute to have baby James safe in my arms.”
Find out more information about diabetes and pregnancy, and read more experiences like Sarah's.