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Confidential Enquiry into Maternal and Child Health

Improving the health of mothers, babies and children


Overview Maternal and Perinatal Health
Maternal & Perinatal Mortality Surveillance
Saving Mothers' Lives
Obesity in Pregnancy
Neonatal Encephalopathy
Diabetes in Pregnancy
Access to Antenatal Care
BEADI
CEMACH/UCL Diabetes Project
Local clinical audits

Child Health
Child Death Review
Head Injury in Children

CEMACH/UCL Diabetes Project

Summary

    

CEMACH is currently working in collaboration with University College London (UCL) Elizabeth Garrett Anderson Institute for Women’s Health on two research projects on diabetes in pregnancy. The projects have been funded by Novo Nordisk, and will run from January 2007 to end of December 2009.

 
Project team
 
Dr Jo Modder
Principal Investigator – CEMACH Clinical Director (Obstetrics) and Consultant Obstetrician, UCLH NHS Foundation Trust
 
Dr Stephanie Baldeweg
Principal Investigator – Consultant Diabetologist, UCLH NHS Foundation Trust
 
Dr Mary Pierce
Principal Investigator – GP/ Clinical Epidemiologist, Department of Epidemiology and Public Health, UCL
 
Ms Iman Mortagy
Research Fellow, CEMACH
 
Ms Heather Hughes
Research Administrator, CEMACH
 
First Study:
 
Factors influencing the uptake of preconception care by women with type 1 and type 2 diabetes from different ethnic groups in London.
 
Background:
 
Preconception care and preparation for pregnancy is a vital part of improving outcomes for this group of women; however, a study by CEMACH on 3808 women with diabetes in pregnancy has been shown that the majority of women with diabetes in England, Wales and Northern Ireland do not prepare adequately for pregnancy. The Diabetes National Service Framework recommends that a preconception clinic should be run jointly by the adult diabetes service and the maternity service.  During the CEMACH survey of maternity services in 2002-2003, only 17% of maternity units in England, Wales and Northern Ireland reported that they provided a multidisciplinary diabetes preconception service.
 
To date, there appears to be a lack of research exploring the perceptions and experiences of women with diabetes in the UK regarding preconception care. It is also not documented in the literature whether health professionals understand why women with diabetes opt not to use the preconception care service in areas where this is available.
 
Aim:
 
To investigate similarities and differences in the perception of women with type 1 and type 2 diabetes and their health providers towards diabetes preconception care, and to outline their solutions and strategies to improve diabetes preconception care uptake.
 
Methods:
 
This is a mixed-method study using qualitative and quantitative research methods and tools.
 
A)     The qualitative tools include focus group, in-depth interviews and observation.
B)     The quantitative tool is a structured postal questionnaire to all health providers working with women with diabetes at University College London Hospitals and in Primary Care within the catchment area of UCLH.
 
Second study
 
Post-pregnancy follow-up for women with gestational diabetes: a review of current practice and an impact assessment of an alternative follow-up strategy.
 
Background:
 
Gestational diabetes mellitus (GDM) is defined as glucose intolerance first recognised during pregnancy. It affects 0.5-15% of all pregnancies and the prevalence appears to be increasing. Insulin resistance plays a role in the development of GDM. Some degree of insulin resistance occurs during normal pregnancy due to the effect of placental hormones such as human placental lactogen, oestrogen and cortisol. In susceptible women, this physiological process leads to gestational diabetes mellitus. Gestational diabetes represents a transient unmasking of a predisposition to diabetes, induced by metabolic changes of pregnancy. The prevalence of GDM has been reported to have doubled between 1994 and 2002. A strong correlation has also been noted between GDM and subsequent development of type 2 diabetes. Studies restricted to the immediate post-partum period have estimated the subsequent risk of developing glucose intolerance to be as high as 36% and the risk of developing diabetes to be 2-16%.
These findings emphasize the importance of post–pregnancy follow up and screening of women diagnosed to have gestational diabetes. To date, however, there is no consensus on how these women should be followed up. The American Diabetes Association (ADA) Expert Committee on the Diagnosis and Classification of Diabetes Mellitus recommends glucose testing using an oral glucose tolerance test (OGTT) 6 to 8 weeks after delivery for women with GDM and, if normal, at a minimum of 3-year intervals. Diabetes UK advises an OGTT 6 weeks postpartum plus a fasting plasma glucose (FPG) at one year and three-yearly thereafter.
 
There is evidence that many women with GDM are not having a 6-week postpartum OGTT to exclude diabetes continuing after pregnancy and are not being appropriately screened for the subsequent development of type 2 diabetes. It is possible that both women and health professionals underestimate the risk of developing diabetes following pregnancy complicated by gestational diabetes.
 
Aim:
 
This study will provide an overview of current practice nationally in post-pregnancy follow up of women with GDM, and will develop a local strategy of follow-up across the primary/secondary care interface, to serve as the basis for a national model of best practice. It is anticipated that such a strategy will result in earlier detection and treatment of diabetes developing in women with previous GDM. 
 
Methods
A) Observational study
 
This phase includes an overview of previous and current practice at UCLH;  the development of an alternative follow-up strategy; implementation and evaluation of the alternative strategy
B) National survey
The survey is restricted to England and will investigate current practices of follow up for women with gestational diabetes in terms of a) the 6 week OGTT b) subsequent follow up to test for the development of diabetes. 

For further information on these studies, please contact Iman Mortagy on 020 7486 1191


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