The second report from the National Pregnancy in Diabetes (NPID) audit of joint diabetes and maternity services in England, Wales and the Isle of Man has been published, revealing that women with diabetes generally enter pregnancy poorly prepared and that outcomes in 2013–2014 have changed little since the Confidential Enquiry into Maternal and Child Health (CEMACH) report from 2002–2003.
The NPID audit sought to assess the quality of care received by women with diabetes who become pregnant, in accordance with the NICE CG63 and NG3 guidelines, by addressing three questions:
- Were women with diabetes adequately prepared for pregnancy?
- Were adverse maternal outcomes minimised?
- Were adverse fetal/infant outcomes minimised?
Data on 2553 pregnancies ending in 2014 were submitted by 150 maternity units. The findings showed that women with diabetes were generally poorly prepared for pregnancy, with only 41.9% taking preconceptual folic acid and only 25.6% achieving an HbA1c below the NICE-recommended level of 48 mmol/mol (6.5%) in the first trimester. Only 52.0% of women with type 1 diabetes and 36.7% of those with type 2 diabetes had their first contact with a specialist joint antenatal and diabetes team within the first 8 weeks of gestation as recommended.
In terms of maternal outcomes, just 13.6 per cent of women went into spontaneous labour, less than the 18.0% in the CEMACH report 10 years ago. Rates of caesarean section were higher than in the general population (60.1% vs. 26.2%; however, the rate of emergency caesareans fell to 30.0% compared with 37.6% in 2003.
Regarding fetal and infant outcomes, there were 12.8 stillbirths per 1000 deliveries, 7.6 neonatal deaths per 1000 live births and 44.2 congenital anomalies per 1000 deliveries. The risk of congenital anomalies was higher in women with higher first-trimester HbA1c levels. Overall, 34.3% women with type 1 diabetes and 23.1% of those with type 1 diabetes had large-for-gestational-age babies.
Based on these disappointing findings, the report makes a number of recommendations to improve education and support for women with diabetes who are planning pregnancy, with diabetes and maternity services, strategic networks, primary care and the patients themselves all targeted for intervention.
The report can be read in full here.
