CEMACH release: Diabetes and pregnancy – forewarned is forearmed

The Confidential Enquiry into Maternal and Child Health (CEMACH) will launch its report on pregnancy and childbirth Diabetes in pregnancy: are we providing the best care? Findings of a national enquiry , on 26 February 2007.

The report focuses on women in England, Wales and Northern Ireland who already had diabetes (type 1 and type 2 diabetes) before becoming pregnant.

Pre-existing diabetes affects approximately 1 in 250 pregnancies in England, Wales and Northern Ireland. It leads to a higher caesarean section rate and is associated with adverse pregnancy outcomes such as higher rates of stillbirth, structural abnormalities in babies including heart and spine defects, and deaths in the first month of life.

In pregnancy, women who have type 2 diabetes are more likely to be older, obese, come from a minority ethnic group and be socially deprived, than women with type 1 diabetes.

The findings of the CEMACH report reveal that women with diabetes do not appear to be receiving enough support from their GPs and the NHS. Preconception care tends to be poor and uncoordinated. Many women do not receive preconception counselling, contraceptive advice and appropriate screening. Less than half the women in the study took folic acid supplements prior to pregnancy and were not advised about proper glycaemic control, healthy eating and controlling their alcohol intake. There was evidence that the care provided to women with type 2 diabetes was of a lower standard than that provided to women with type 1 diabetes.

The study's recommendations address the need for better clinical care and diabetes management before, during and after pregnancy, easier access to specialist services and advice, mechanisms to identify at-risk groups or individuals, and improved services.

Richard Congdon, Chief Executive of CEMACH said, “This report focuses on the need for an effective partnership between clinicians and the women themselves in managing diabetes before, during and after pregnancy. The report provides evidence that this partnership does not always work well. We hope that our recommendations will act as a catalyst for local action to strengthen this approach to care."

Dr Jo Modder, Clinical Director (Obstetrics) of CEMACH said, “This report provides clear evidence that women with diabetes are not being empowered to prepare adequately for pregnancy, and that health professionals are often not providing the appropriate information and care. Women who have diabetes before pregnancy should access specialist services before conception, take steps to prevent an unplanned pregnancy, and commence higher dose (5mg) folic acid before they conceive."

Douglas Smallwood, Chief Executive of Diabetes UK, said: “We welcome CEMACH's recommendations as a way forward in providing the best possible care for women with diabetes when they are thinking of having a baby, throughout pregnancy and after childbirth."

“We need to work together to ensure that women with diabetes and people involved in their care are well equipped and are taking all necessary steps to minimise risks."

“The recommendations need to be implemented by health service professionals and commissioners alike to make sure that pregnancy and childbirth is a happy and safe time for all concerned."

Mr Richard Warren, Honorary Secretary of the Royal College of Obstetricians and Gynaecologists (RCOG) said, “It is essential that the needs of diabetic women are fully realised and that they receive high quality clinical care before, during and after pregnancy."

“The RCOG welcomes this important Report which highlights areas of concern and calls for improved care as well as better working relationships between GPs, midwives and specialists so that the risks and problems associated with maternal diabetes may be reduced."



Confidential Enquiry into Maternal and Child Health. Diabetes in Pregnancy: Are we providing the best care? Findings of a National Enquiry: England, Wales and Northern Ireland. CEMACH; London: 2007.

The Confidential Enquiry into Maternal and Child Health (CEMACH) aims to improve the health of mothers, babies and children by carrying out confidential enquiries on a nationwide basis and by widely disseminating its findings and recommendations. CEMACH started in 2003 and its remit includes conducting studies into maternal deaths, stillbirths and deaths in infancy. For more information, please visit www.cemach.org.uk .

For more information on this release, please call Rosie Houston at CEMACH On 0207 467 3228 or email rosie.houston@cemach.org.uk .

To contact Diabetes UK, please e-mail sarah.milsom@diabetes.org.uk or call

020 7424 1164.

Date published: 26/02/2007
Published by: Website Manager
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