Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. In addition, diabetic retinopathy can worsen rapidly during pregnancy 1.
Reducing harm from diabetes in pregnancy
Good pre-pregnancy care for patients with diabetes improves glucose control and reduces risks associated with diabetes in pregnancy. The PROCEED case study – safe pre-pregnancy care in diabetes report from the Health Foundation describes a community based multi-disciplinary intervention in Derby Hospitals NHS Foundation Trust to improve pre-pregnancy care.
Guidance on the care of pregnant patients, both with pre-existing and gestational diabetes, is reviewed in the NICE guideline Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. It builds on evidence for best routine care to highlight where different care should be in place for women with diabetes and their babies.
NHS Diabetes have created a patient information leaflet, SAFER, outlining steps for optimal pre-pregnancy care for women with diabetes. It encourages patients to consider their diabetes before getting pregnant and to engage with specialist care services.
The West Midlands region of the UK undertook work as part of a national enquiry into maternity care for patients with diabetes, the West Midlands Confidential Enquiry into Diabetes in Pregnancy. The enquiry highlights areas of care which remain sub-optimal and should provide a starting point for reducing harm for women with diabetes in pregnancy.