Published on 21 October 2016

A lack of preparation during pregnancy could increase the risk of complications for women with diabetes, according to a new NHS report.

The National Pregnancy in Diabetes Audit 2015, published by NHS Digital, Diabetes UK and the Healthcare Quality Improvement Partnership (HQIP) found that few women with diabetes who become pregnant are well prepared – despite help and advice being available from healthcare professionals.

The report highlighted that many women are ignoring the advice in the national guidelines published by NICE – which can lead to an increased risk of birth defects, stillbirth and large babies.

Mothers to be with diabetes can avoid complications by getting information and support from healthcare teams

In a study of more than 3,000 women with diabetes who were pregnant, the report found that just 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. With just 16% of women with type 1 diabetes and 38% with type 2 diabetes having blood glucose levels within the recommended range in the critically important early weeks of pregnancy.

A pregnant woman holding her stomach.

The report added that many women were also making their first contact with antenatal diabetes services much later than recommended. Just over half (55%) of women with type 1 diabetes and 36% of women with type 2 diabetes reportedly had no contact with an antenatal diabetes specialist team during the first eight weeks of pregnancy.

The report found that the stillbirth rate amongst women with both type 1 and type 2 diabetes had more than halved since the last comparable study was made (Confidential Enquiry into Maternal and Child Health in 2003). However, these figures are much higher than in the overall population – with 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 was also reported to be more common when the mother has diabetes. Neonatal deaths happened in 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.

Dr Nick Lewis-Barned, a Specialist Diabetes Physician and clinical lead for the audit, said: “Over 3,000 women and 155 specialist teams worked together to provide information for this report. Thanks to them we know that many pregnant women with diabetes have worse outcomes than women without diabetes – and that this is often avoidable.

“The key things that can help to reduce the risks for these women and their babies are easy to identify – 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.

“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.”

The report can be downloaded here

The NICE guidelines, Diabetes in Pregnancy: management from preconception to the postnatal period, include advice on managing diabetes and its complications in women who are planning pregnancy or are already pregnant. It aims to improve the diagnosis of gestational diabetes and help women with diabetes to self-manage their blood glucose levels before and during pregnancy.

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