Diabetes: lack of blood sugar control putting pregnancies at risk, national audit finds
Published: 18 Nov 2015
Three out of four (74%) pregnant women with diabetes have higher than recommended blood sugar levels in early pregnancy, new findings from a national audit reveal.
The audit’s lead clinician, Dr Nick Lewis-Barned, is now calling for local diabetes teams, general practices and maternity services to work together to help increase awareness among women with diabetes that high blood glucose levels and a lack of preparation for pregnancy can increase the risk of adverse pregnancy outcomes. Such outcomes include stillbirths, neonatal deaths, and babies born with congenital abnormalities.
Read the full report
The National Pregnancy in Diabetes (NPID) audit, which is managed by the Health and Social Care Information Centre in partnership with Diabetes UK supported by Public Health England, measures the implementation of national guidance on the care of women with diabetes who become pregnant. It forms part of the National Clinical Audit programme, commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England and the Welsh Government.
Today’s report shows that among 2,537 women with diabetes who were pregnant in 2014 in England, Wales and the Isle of Man:
- Women with Type 1 diabetes were more likely to have blood glucose levels above the National Institute for Health and Clinical Excellence (NICE) guideline in early pregnancy
- This was the case for 85% (or 815) of women with Type 1 diabetes and for 64% (or 491) of women with Type 2 diabetes
- Almost 12% (112) of women with Type 1 diabetes and 8% (62) of women with Type 2 diabetes had blood glucose levels above the level where women are advised to avoid pregnancy
- Just over half of women (51% or 601) with Type 1 diabetes and only one-third (33% or 355) of women with Type 2 diabetes were taking folic acid supplements prior to becoming pregnant
- One in 10 (11% or 112) women with Type 2 diabetes were taking medication when they became pregnant that can cause harm to the baby
As adverse outcomes are relatively rare, the audit report has analysed 2013 and 2014 data together. Women whose baby was born with a congenital abnormality were more likely to have had high blood glucose levels in early pregnancy. Only 17% (23) of women who had babies with congenital abnormalities had blood glucose levels in early pregnancy within the recommended range, compared with 25% (680) of women who had babies with no abnormality that survived for at least 28 days after birth.
The NPID Audit Report 2014 includes data from 150 participating organisations across England, Wales and the Isle of Man. Compared to the first audit in 2013, the number of organisations taking part has increased by 22.
Audit Lead Clinician and advisory group chair, Dr Nick Lewis-Barned said: “There are three key elements of pregnancy preparation for women with diabetes to reduce the risk of adverse pregnancy outcomes – good control of blood glucose levels, taking folic acid supplements and a medication review. It’s clear from the audit that many women need more information and more support in all of these areas.
“This means we need to work much more effectively on improving links between policy makers, commissioners, acute trusts, clinical teams, and local general practices and the community to ensure that women get the support they need to have healthy pregnancies.”