Women with diabetes in the UK who become pregnant face an increased risk of complications because of a lack of preparation for pregnancy, according to a new report.
Few of them are well prepared for coping with their condition during pregnancy despite agreed national guidelines resulting in increased risk of congenital abnormalities, stillbirth and large babies.
The latest National Pregnancy in Diabetes Audit published by NHS Digital, charity Diabetes UK and the Healthcare Quality Improvement Partnership found that out of 3,000 women with diabetes who were pregnant, only 46% with type 1 diabetes and 23% with type 2 diabetes were taking the recommended 5mg of folic acid prior to conception.
Most women also had high blood glucose levels. Just 16% of those with type 1 diabetes and 38% of those with type 2 diabetes had blood glucose levels within the recommended range in the critically important early weeks of pregnancy.
First contact with antenatal diabetes services was later than recommended for many women, the study also found. Some 55% of women with type 1 diabetes and 36% of women with type 2 diabetes had no contact with an antenatal diabetes specialist team during the first eight weeks of pregnancy.
The report points out that while stillbirth rate amongst women with both type 1 and type 2 diabetes has more than halved since comparable figures were published by the Confidential Enquiry into Maternal and Child Health in 2003, it remains much higher than in the overall population.
Stillbirth was recorded in 10.7 per 1,000 births for women with type 1 diabetes and 10.5 per 1,000 for type 2 diabetes, compared with 4.7 per 1,000 in the general population.
A baby dying during the first 28 days of life is also more common when the mother has diabetes. Neonatal deaths occurred for 8.1 per 1,000 live births where the mother had type 1 diabetes and 11.4 per 1,000 with type 2 diabetes, compared with 2.5 per 1,000 in the general population.
‘Many pregnant women with diabetes have worse outcomes than women without diabetes and that this is often avoidable,’ said Dr Nick Lewis-Barned, a specialist diabetes physician and clinical lead for the audit.
‘The key things that can help to reduce the risks for these women and their babies are easy to identify such as taking 5mg folic acid daily starting well before pregnancy, having the best possible glucose control, and stopping any treatments that might cause harm. At the moment this isn’t happening consistently enough,’ he explained.
‘Good information and support from their usual diabetes team when thinking about pregnancy, and contact with specialist antenatal teams before and early in pregnancy, can help women to achieve this. If these outcomes are to improve we need to find ways to work with women much more effectively to be ready for pregnancy,’ he added.
The opinions expressed in this article do not necessarily reflect the views of the DiabetesForum.com Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.