Foreword

 
     

With diabetes affecting a large and growing number of women of childbearing age, this report and its comprehensive analysis of care before, during and after pregnancy is very timely. The Confidential Enquiry into Maternal and Child Health (CEMACH) has carried out what is believed to be the world's largest ever survey of pregnant women with diabetes and their findings make compelling and, in some instances, disturbing reading for both healthcare professionals working with diabetes and their female patients.

The detailed evidence on the outcomes of pregnancy for both mother and child and the increased risk of stillbirths, premature or caesarean delivery and malformation provide valuable insights to healthcare professionals as well women with diabetes considering pregnancy.

Their findings and recommendations pose a considerable number of challenges to local NHS organisations, diabetes professionals and women with diabetes who are or who wish to become pregnant.

For local NHS organisations, the focus will be on the increased resources and changes in care processes that will be required to provide the highest possible standard of care for their female patients. They will need to ensure that a woman with diabetes receives an effective service that integrates prepregnancy counselling, primary care responsibilities and essential specialist care. In particular, it is critical that women of childbearing age are supported to have much improved blood glucose levels when they enter pregnancy. This may mean looking at existing structures, workforce skills and systems to ensure they are working effectively together and developing entirely new approaches to involving women based in the very diverse communities in which they live. Outcomes must be improved and inequalities reduced.

For the diabetes healthcare community, it means working within integrated services and strengthening multidisciplinary teams in both primary and specialist care, to ensure that pregnant women with diabetes have a seamless pathway from wishing to become pregnant to delivering a healthy child. Ensuring along the way that their patients receive all the essential support and information to truly involve them in managing their own condition.

For women with diabetes who are planning to become pregnant, there is a real opportunity to increase their chances of having a healthy pregnancy. By actively working with their local care teams as well as specialist services and by becoming involved in the patient education and advice that will be offered they can make a real difference to their pregnancy and their child.

Although the main message of this report is that that there is an increased risk of experiencing a stillbirth, induced and caesarean delivery and of having a baby with a congenital anomaly, there is good news. CEMACH found that 59% of pregnancies went to term and, after 28 days, 86% of babies were alive and without any diagnosed major congenital anomaly. So, although women with diabetes need to be aware of the risks, they must also be aware that these can be reduced if not eliminated; that there is a good chance for a healthy pregnancy and a healthy baby.

Sue Roberts

National Clinical Director for Diabetes