Diabetes in Pregnancy

Why it is a priority

For women who are pregnant, any form of diabetes can affect childbirth outcomes including potentially severe health effects on both the baby and the mother. The anticipated experience of pregnancy and birth can change too.

Many women go on to have healthy babies and accept the extra monitoring, medication and necessary lifestyle changes, as they understand the importance of this in pregnancy. However, the latest National Pregnancy in Diabetes (NPID) Audit was published in October 2019 and showed there were still major differences in outcomes for women affected by diabetes, compared to women without diabetes.

Specifics from the NPID summary:

• “Neonatal death, stillbirth, congenital anomaly, large and small for dates babies, and neonatal unit admission all remain very high by comparison with non-diabetic pregnancies and so are of considerable concern
• There are higher rates of anomalies, stillbirths and neonatal deaths (98.6% live births) than in the non-diabetes population (99.6% live births)
• Seven in eight women did not achieve NICE-recommended, risk reducing, pregnancy preparation. These results are unchanged over 5 years.

Over half of women included in this audit in England and Wales for 2018 have Type 2 diabetes which is an increase; the comment is that more women may access diabetes care via general practice where pregnancy planning may not be uppermost.

Continuous glucose monitoring in pregnancy for women with Type 1 diabetes helps to improve neonatal outcomes – there is wide variation in the availability of this technology.

The vast majority of women with diabetes went through their pregnancy and childbirth safely without serious complications - for more information on what you can do to lower the risk even before trying for a baby please visit: https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy

For health professionals – please see the links below to ensure your practice is up to date and helpful to local people.

Our work

• Working with the Clinical Network for Maternity to enhance multidisciplinary awareness and collaborative working across Yorkshire & the Humber for the benefit of women with diabetes in pregnancy
• Diabetes in pregnancy group relaunched October 2019 with further events/work planned
• Gestational diabetes – local consensus guidelines being written on late-presenting gestational diabetes, as there is variation in practice due to minimal evidence and guidelines
• Working with the National Programme Team to implement the increased use of continuous glucose monitoring in pregnancy for women with Type 1 diabetes from spring 2020, and other technologies as evidence emerges

The Yorkshire and Humber Clinical Network continues to work with providers and commissioners to share good practice and improve care for women with diabetes across Yorkshire and the Humber. If you would like to join the Diabetes in Pregnancy mailing list, please let us know england.yhdiabetescn@nhs.net

Links and Documents

Diabetes UK advice on diabetes and pregnancy (includes advice on gestational diabetes)

Gestational diabetes interactive website

National Pregnancy in Diabetes Audit Report 2018

NICE pathway guidance on diabetes in pregnancy (regularly updated)

Resources for diabetes and pregnancy compiled by Diabetes UK, includes links to e-learning as well as printable leaflets for women with diabetes

Tommy’s pregnancy planning website gives a personalised report on planning for pregnancy encompassing all common factors that can make a pregnancy safer