Women with diabetes at increased risk of developing complications due to poor planning is “avoidable”
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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