Gaps in the support available to women with diabetes before and during pregnancy are leaving thousands at risk of serious complications.
Gaps in the support available to women with diabetes before and during pregnancy are leaving thousands at risk of serious complications, Diabetes UK has warned. The 2017/2018 National Pregnancy in Diabetes (NPID)1 audit for England, Wales and the Isle of Man found that:
- Almost one in two babies of women with diabetes are large for their gestational age
- Admissions to neonatal units remain very high for babies of women with diabetes when compared to the general population
This situation has remained unchanged since the audit began in 2013.
The audit also revealed that between 2017/2018, while the vast majority of women with diabetes went through pregnancy safely and without serious complications, 170 out of 8255 pregnancies recorded in the NPID resulted in stillbirth or neonatal death, which makes women with diabetes 3 – 4 times more likely to experience such serious complications when compared to the general population in England and Wales.
The charity’s analysis of the latest audit of pregnancies in diabetes has shown that – despite progress to improve care in some areas – women with diabetes are still experiencing significantly poorer outcomes in pregnancy than the general population.
Yet, while there are steps that can be taken to reduce the risk of complications, the audit also revealed that seven out of eight women with diabetes were still not achieving NICE-recommended risk-reducing pregnancy preparations.
Progress is being made to make pregnancy safer for women with diabetes; earlier this year it was announced that Continuous Glucose Monitors would be made routinely available for all pregnant women living with type 1 diabetes in England by 2021.
But the charity warned that, in addition to clinicians keeping pre-pregnancy support front of mind, further evidence-based interventions for women with type 2 were also needed in order to help this group manage their risk during pregnancy.
For the first time, more women with type 2 diabetes were included in the audit than women with type 1. The charity cautioned that, while more women are now being diagnosed with type 2 earlier in life, healthcare professionals may not be discussing pre-pregnancy planning with this group, and urged clinicians to be aware of the differences in care women with different types of diabetes may need.
With more than 50% of pregnant women with type 2 diabetes recorded in the audit being from non-white backgrounds, and over 60% living in some of the most deprived socio-economic areas, the charity also said action was needed to support women from these groups.
Nikki Joule, Policy Manager at Diabetes UK, said: “The audit highlights that women with diabetes – regardless of whether they live with type 1 or type 2 diabetes – are still at a far greater risk of serious pregnancy and child birth complications. This needs to change, and clinicians can lead the way in turning the tide.
“We’ve seen progress in this area – such as the decision to roll out Continuous Glucose Monitoring devices for pregnant women in England with type 1 diabetes – which is a positive move. But service-wide interventions need to be made to reduce the number of devastating pregnancy complications for all women with diabetes.
“We know that more women are developing type 2 at a younger age, so it’s also important that healthcare professionals raise the issue with this group – and the steps they can take to have the safest pregnancy possible – before they begin trying to conceive.”
There are three ways to improve pregnancy outcomes for women. These are:
- Ensuring that HbA1c (Haemoglobin A1C diagnostic test measuring the average blood glucose levels for the last two to three months) is at the recommended safe levels before getting pregnant – or as soon as women are aware they are pregnant
- Taking high dose folic acid – before getting pregnant – or as soon as women are aware they are pregnant
- Reviewing medication – before getting pregnant – or as soon as women are aware they are pregnant, as some type 2 medications, as well as some medications for blood pressure and cholesterol, should not be used during pregnancy.
Supporting women outside of clinical appointments is also very important, as steps such as checking your blood sugar more regularly, eating a healthy diet, and being more active can also be helpful. Information on pregnancy and diabetes is available on the Diabetes UK’s website at https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy
