Pathways for non-healing ulcers
Q In women with diabetes, how do people approach preconception care? Additionally, what strategies have other clinics developed for ensuring women who are pregnant and frequently do not attend appointments receive suitable care?
Name and address withheld
A We have run a preconception clinic since 2003 and are always striving to try and ensure women with diabetes receive appropriate advice. We have sent letters out to primary care recommending referral for preconception care. I have produced a leaflet for women that I ask practice nurses to discuss and give out at annual review, which includes contact numbers for women to arrange an appointment at the clinic. We advertise the clinic in all GP practices across the local area as well as at diabetes outpatient clinics. Recently we organised an evening for 14–17 year olds to discuss the importance of accessing preconception care. Despite this, the numbers attending are small but we continue to try and encourage uptake of preconception care.
Fortunately we do not seem to have a big problem with women not attending their appointments. I always contact them by phone if possible but if they are persistent then I do a home visit to try and find the reasons behind non-attendance.
Jane O’Brien, Diabetes Specialist Midwife, Stockport NHS Foundation Trust
A Preconception care for women with diabetes should include the following.
- Assessment and management of any complications (such as retinopathy, nephropathy, associated medical problems) and discontinuation of any teratogenic drugs.
- Counselling: explanation of objectives and risks, advice on general health and lifestyle measures including smoking cessation support. Dietary advice should include folic acid supplementation (dose 5mg daily).
- Glycaemic control should be optimised: preferably a capillary blood glucose level of 3.5–6 mmol/l pre-meal and lowest possible HbA1c without problematic hypoglycaemia.
- Ensure discussion of pregnancy risks in diabetes and expected management is clearly documented.
- Continuation with appropriate contraception to ensure planned pregnancy.
Tina Ali, DSN, Aintree University Hospitals NHS Foundation Trust
Su Down looks back on a year of change and achievement.
17 Dec 2024