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S`  C *APicture1"   0̟ Y&  TCEMACH Diabetes in Pregnancy National Report Launch, Sheffield, 26th February 2007UU   nAL Y?$dv418111ucPreview_imgMain#" `SH  0޽h ? 3380___PPT10.O2 Default Design  0 kc@(    6ď > T Click to edit Master title style! !  0T  `  W#Click to edit Master subtitle style$ $  nAL Y?$dv418111ucPreview_imgMain#" `S`  C *APicture1"H  0޽h ? 3380___PPT10.OO 0 zr` (    0(hc P   fP*    0pc    fR*  d  c $ ?  f  0hc  0 fRClick to edit Master text stylesSecond levelThird levelFourth levelFifth level!   S  6TOc _P  cP*    6@Sc _  cR*  H  0޽h ? 3380___PPT10.Q, 0 p(  p p 6|“ % ]+A Comparison of type 1 and type 2 diabetes ,,( p 0콓Jc EDr Bob Young (2H p 0޽h ? 3380___PPT10.P@v + 0  dQ(  d~ d s *xM,G M  d H$3M ?"6@ NNN?N *Source: Confidential Enquiry into Maternal and Child Health: Pregnancy in women with type 1 and type 2 diabetes in 2002-03, England, Wales and Northern Ireland. CEMACH: London; 2005.  2  d0  `A ? ?H $ 0 MH d 0޽h ? 3f3fg___PPT10.𔊣+ Do' =@B D*' =@BA?%,( < +O%,( < +Da' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*d%(+0+(+d 0+5M, 0  66ly(  lL l c $X99? ) l Bp=M ?"6@ NNN?N  ;8.5 l BAM ?"6@ NNN?N Rn ;3.6T l S 3f"`` T l S 3f"` T l S 3f"` :2 T l S "` T  l S "` T  l S "` 2$ T  l S ̙"`  T  l S ̙"` T l S ̙"`c $ :B l 3 3f! :B l 3 3f1 3 :B l 3 3f  :B l 3 3f:B l 3 3f,-:B l 3 3f~:B l 3 3f:B l 3 3f!#:B l 3 3f  :B l 3 3f > @  :B l 3 3f  :B l 3 3f   l 6MMp ~ I9.6*F l 6QM {J31.7*F l 0WMn0J25.8*F l 6[MS~ I9.5*F l 6YM NJ32.3*F l 6HeMP~J29.2*F  l 6iM 0j G0*F !l 6nM 0jh G5*F "l 6sM= X H10*F #l 6 yMX H15*F $l 6(~MXcH20*F %l 6DMKeH25*F &l 6p@MXH30*F 'l 6\MXZH35*FT (l S 3f"`{. )l 60K]VfUType 1 diabetes*FT *l S "`, +l 6 KfVfUType 2 diabetes*FT ,l S ̙"`, -l 0tKpVo)England, Wales & Northern Ireland (2002) **)F .l Ba ?"6@ NNN?N b.*per 1000 total births **per 1000 live births// H /l 3 A"2 0l <a ?"6@ NNN?NS Z ;5.7x 1l c $`a`!] a  2l 6a m VStillbirth rate**F 3l 6a ?  KPNMR**F 4l 6<a p] TNeonatal death*F 5l 6a) &5 Lrate***F| 6l BXa ?"6@ NNN?N&t Source: Confidential Enquiry into Maternal and Child Health: Pregnancy in women with type 1 and type 2 diabetes in 2002-03, England, Wales and Northern Ireland. CEMACH: London; 2005. <&  & V l 0޽h ?"` 3f3fg___PPT10i.Qf+D=' =@B +'!- 0 > 6 $$t(  t~ t s *&a, a  j  t# #"*r@  a t H.a?"6@ NNN?N J5.2% @` t B'a ?"6@ NNN?N  K2.2%  @` t B?a ?"6@ NNN?N  KOther @` t HHa?"6@ NNN?NJ0.5% @` t BPa ?"6@ NNN?N J0.1% @`  t B Ya ?"6@ NNN?N MChinese @`  t Hba?"6@ NNN?N<O29.4% @`  t B8ka ?"6@ NNN?N <N3.3% @`  t Bta ?"6@ NNN?N< OAsian @` t H`}a?"6@ NNN?N<O13.5%f @` t Bna ?"6@ NNN?N <O2.9% f @` t Ba ?"6@ NNN?N <OBlackf @`  t Ha?"6@ NNN?NK51.2% @` t BTa ?"6@ NNN?N L91.3%  @` t BШa ?"6@ NNN?N KWhite @`  t HLa?"6@ NNN?NjLType 2 @` t Bȹa ?"6@ NNN?N jLType 1 @` t BD ?"6@ NNN?Nj > @`B t <o ?"0@NNN?NjjB t 61 ?"0@NNN?NB t 61 ?"0@NNN?NB t 61 ?"0@NNN?N<<B t 61 ?"0@NNN?NB t 61 ?"0@NNN?NB t <o ?"0@NNN?N  B t <o ?"0@NNN?Nj B t 61 ?"0@NNN?N j  B t 61 ?"0@NNN?Nj B  t <o ?"0@NNN?Nj  !t B ?"6@ NNN?Nc )  "t B ?"6@ NNN?N 7g H #t 3 A"2| $t BpD ?"6@ NNN?Nf&t Source: Confidential Enquiry into Maternal and Child Health: Pregnancy in women with type 1 and type 2 diabetes in 2002-03, England, Wales and Northern Ireland. CEMACH: London; 2005. <&  & V t 0޽h ?"` 3f3fg___PPT10i.`nV+D=' =@B +g#. 0 ~"v" %%|"(  |~ | s *,a, a   |# #"."8ZFFFU a | Ba ?"6@ NNN?N l L1% @` | B`D ?"6@ NNN?NN l L2% @` | B0D ?"6@ NNN?Nl N ZMissing postcode @` | B8D ?"6@ NNN?N & l O45% @` | B8AD ?"6@ NNN?NN & l K22% @`  | BJD ?"6@ NNN?N& N l Y5 (most deprived) @`  | BRD ?"6@ NNN?N  & K23% @`  | B[D ?"6@ NNN?NN & K20% @`  | BdD ?"6@ NNN?N N & I4 @` | BLmD ?"6@ NNN?N  K14% @` | Bt_D ?"6@ NNN?NN   K20% @` | BD ?"6@ NNN?NN I3 @` | BtD ?"6@ NNN?N @K11% @` | ByD ?"6@ NNN?NN @ K19% @` | BD ?"6@ NNN?N@N I2 @` | B  ?"6@ NNN?N @K7%  @` | B, ?"6@ NNN?NN  @K17% @` | B- ?"6@ NNN?NN @Z1(least deprived)  @` | B= ?"6@ NNN?N NType 2 @` | BF ?"6@ NNN?NN  NType 1 @`( | B(O ?"6@ NNN?NN p*Quintiles of Index of Multiple Deprivation++ @`B | <o ?"0@NNN?NB | 61 ?"0@NNN?NB | 61 ?"0@NNN?N@@B | 61 ?"0@NNN?NB | <o ?"0@NNN?NB | <o ?"0@NNN?NB | 61 ?"0@NNN?NN N B  | 61 ?"0@NNN?N  B !| <o ?"0@NNN?NB "| 61 ?"0@NNN?N  B #| 61 ?"0@NNN?N& & B $| 61 ?"0@NNN?Nl l z %| BS ?"6@ NNN?Nr Source: Confidential Enquiry into Maternal and Child Health: Pregnancy in women with type 1 and type 2 diabetes in 2002-03, England, Wales and Northern Ireland. CEMACH: London; 2005. <&  & V | 0޽h ?"` 3f3fg___PPT10i.`nV+D=' =@B + 0  0(  x  c $D,0P D x  c $ЇD'g  D H  0޽h ? 33___PPT10i./I@3M+D=' =@B +/ 0 3+ (  ~  s * fD,tI D   00b All women in the enquiry with good pregnancy outcome 170 type 1 diabetes127 type 2 diabetes An equivalent proportion of type 1 and type 2 diabetes with a poor pregnancy outcome sampled from 3808 diabetic pregnancies11 type 1 diabetes10 type 2 diabetes6P(P}P&PP4 (|& H  0޽h ? 33___PPT10i.P~+D=' =@B +0 0 @ m(  ~  s *H:D / D   H ?"6@ NNN?N # E62% 2 0  `A  ? ?8  DH  0޽h ? 33___PPT10i.P+D=' =@B +)1 0 @8` (  x  c $   0  `A  ? ?z     H ?"6@ NNN?NEp=0.001 2a  H ?"6@ NNN?N \g For women with type 2 diabetes, planning a pregnancy may not necessarily equate with contraceptive useh 2hH  0޽h ? 33___PPT10i.@I++D=' =@B +2 0  j(  ~  s *`h,  h  0  `A  ? ?   hH  0޽h ? 33___PPT10i.CID+D=' =@B +  0   (  x  c $p] `    s 40e0e 3"0e`,   H  0޽h ? 33___PPT10i.CI`I+D=' =@B +/)3 0 F(>( ""'(  ~  s *,   ' Tq # #"&Tq   N ?"6@ NNN?N@ q @ @`  N ?"6@`NNN?N @ ~v0___PPT106___PPT9c 1/9 (11)( (" " @`  Ț ?"6@`NNN?N ~v0___PPT106___PPT9W 9/50 (18) ( " @`  TT ?"6@`NNN?NT  ~v0___PPT106___PPT9jPre-existing and deteriorating " @`  Nh ?"6@ NNN?N@ q@ @`   N ?"6@`NNN?N @~v0___PPT106___PPT9g 5/9 (56), (" & @`   N ?"6@`NNN?N ~v0___PPT106___PPT9e 13/50 (26)( (" " @`   N ?"6@`NNN?NT ~v0___PPT106___PPT9d New finding& " " @`   NL ?"6@ NNN?N@q @ @`  N ?"6@`NNN?N@ ~v0___PPT106___PPT9c 3/9 (33)( (" " @`  TPH ?"6@`NNN?N ~v0___PPT106___PPT9X 25/50 (50) ( " @`  T0R ?"6@`NNN?NT ~v0___PPT106___PPT9<Pre-existing  no change " @`'  TT?"6@ NNN?N@q]<0.001$  @`  T<_?"6@`NNN?N@~v0___PPT106___PPT9g 9/96 (9), (" " @`  Z>?"6@`NNN?N~v0___PPT106___PPT9[ 50/138 (36) ( " @`  Zp9?"6@`NNN?NT~v0___PPT106___PPT9fRetinopathy in pregnancy " @`  N ?"6@`NNN?N@q~v0___PPT106___PPT9Up-value(" @`  T' ?"6@`NNN?N@~v0___PPT106___PPT9\Type 2n/N (%)(" @`  T\# ?"6@`NNN?N~v0___PPT106___PPT9_Type 1 n/N (%)( " @`   Td ?"6@ NNN?NT@ @`B  <o ?"0@NNN?NTqB  61 ?"0@NNN?NTqB  61 ?"0@NNN?NTqB  61 ?"0@NNN?NT q B  <o ?"0@NNN?NTqB  <o ?"0@NNN?NTTB  61 ?"0@NNN?NB  61 ?"0@NNN?NB   61 ?"0@NNN?N@@B ! <o ?"0@NNN?NqqB " 61 ?"0@NNN?NT q H  0޽h ? 33___PPT10i.4I=`+D=' =@B +4 0  ,(    s |v0e0e #" 0e,   P 'g  # #"oo/9>    N ?"6@`NNN?N0g Y<0.001  @`  N&Q ?"6@`NNN?Nv0 ~v0___PPT106___PPT9d 4/102 (4)( (" " @`  T(Q ?"6@`NNN?Nv ~v0___PPT106___PPT9Y 33/123 (25) ( " @`  TD)Q ?"6@`NNN?N' ~v0___PPT106___PPT9`Severe hypoglycaemia " @`  N\Q ?"6@`NNN?N0gY<0.001  @`   NQ ?"6@`NNN?Nv0~v0___PPT106___PPT9f 25/121 (21)((" " @`   THQ ?"6@`NNN?Nv~v0___PPT106___PPT9Z 105/171 (61)(" @`   TlQ ?"6@`NNN?N'~v0___PPT106___PPT9cRecurrent hypoglycaemia " @`   NvQ ?"6@`NNN?N0g~v0___PPT106___PPT9Up-value(" @`  T\Q ?"6@`NNN?Nv0~v0___PPT106___PPT9\Type 2n/N (%)(" @`  TQ ?"6@`NNN?Nv~v0___PPT106___PPT9_Type 1 n/N (%)( " @`   TQ ?"6@`NNN?N'@ @`B  <o ?"0@NNN?N'gB  <1 ?"0@NNN?N'gB  <1 ?"0@NNN?N'gB  <o ?"0@NNN?N' g B  <o ?"0@NNN?N'' B  <1 ?"0@NNN?N B  <1 ?"0@NNN?Nvv B  <1 ?"0@NNN?N00 B  <o ?"0@NNN?Ngg   HPQ ?"6@ NNN?N Y Recurrent and severe hypoglycaemia was more common in type 1 diabetes, but a fifth of women with type 2 diabetes had recurrent episodes of hypoglycaemia( 2H  0޽h ? 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Ko%;Q3~աϧqu_YI/ȢZ$]6eagaVo@ԡ=%/r'~4T&ZP{J*i\~RM}eE_G*uD򿎸,wN';Hwqpw*wf+woƛ6o^7B;G3Z}6 jݢŲpN"F!kO ޺>rY˿yqq{rnra7?/*[7mu•,E`3ke8Gsq+})=lLX0r0"[,`6^0h@KP /t Are we providing the best care? 7Women with type 2 diabetes are less likely to have had screening for diabetes complications in the 12 months before pregnancy; and less likely to have retinal screening in 1st trimester Women with type 2 diabetes less likely to receive contraceptive advice before discharge from hospital after childbirth Z4ZZZ uRecommendations I#ClinicalDuring pregnancy, retinal and renal screening schedules should be provided for both women with type 1 and type 2 diabetes Advice about hypoglycaemia during pregnancy, including prevention and management strategies, should be provided to both women with type 1 and type 2 diabetes > ZZZ vRecommendations II Audit and ResearchDiabetes networks should audit standards of preconception and pregnancy care for both women with type 1 and type 2 diabetes 8  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~     !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~     !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`acdefghijklmnopqrstuvwxyz{|}~Root EntrydO)X0\PicturesJCurrent UserGSummaryInformation(bTPowerPoint Document(sDocumentSummaryInformation8P Chart MSGraph.Chart.80*Microsoft Graph Chart  Chart MSGraph.Chart.80*Microsoft Graph Chart  Chart MSGraph.Chart.80*Microsoft Graph Chart  Chart MSGraph.Chart.80*Microsoft Graph Chart`/ 0DArialNew RomanTTܖx: 0ܖDTimes New RomanTTܖx: 0ܖ@ .  @n?" dd@  @@`` *   &! 3 "7%&#b$&)2N +; R$`jǪ<"D@G $$$$$b$ft.#b%$$$"$[ϡZX=yAH *"$rȒnypۍ94"$=5)\;"$[-Pd0Gk l+Zl@C 0AA@8R ʚ; f8ʚ;g4BdBdx: 0(ppp@ <4dddd  0T<4!d!d  0T ___PPT10DTimes New RomanTTxx: 0xDArialNew RomanTTxx: 0xpp@  eBBackground: Prevalence of type 1 and type 2 diabetes in pregnancy*CCf\Type 1 and type 2 diabetes  equivalent risks "/-* gXType 2 diabetes  differences in ethnicity "-+*hnType 2 diabetes  differences in social deprivation 084*iAim#To examine any differences in socio-demographic and clinical characteristics, social and lifestyle issues, and clinical care provided to women with type 1 and type 2 diabetes. jMethods#kObesitylPlanned pregnancymPreconception folic acidn Glycaemic control P6Women with type 1 diabetes were more likely than women with type 2 diabetes to have a panel assessment of suboptimal preconception glycaemic control (p= 0.013) Similar to descriptive study of 3808 pregnancies: 24% of type 1 women with preconception HbA1c <7%41% of type 2 women with preconception HbA1c <7%<bbo Retinopathy #pHypoglycaemia#qDifferences in clinical carePWomen with type 2 diabetes were: less likely than women with type 1 diabetes to have a retinal examination in the 12 months before pregnancy (p=0.004) Less likely to have an assessment of albuminuria in the 12 months before pregnancy (p=0.04) less likely to have a retinal assessment in the first trimester of pregnancy (p=0.02)z#PPPWP"w^WrPost natal care zWomen with type 2 diabetes were more likely not to receive postnatal contraceptive advice than women with type 1 diabetes s&Conclusions: clinical characteristicsJEquivalent risks of adverse pregnancy outcomes Women with type 2 diabetes in pregnancy more likely to be obese Pregnant women with type 1 diabetes more likely to have retinopathy, recurrent hypoglycaemia and severe hypoglycaemia But pregnant women with type 2 diabetes can also have recurrent hypoglycaemia and new retinopathy>KP /t Are we providing the best care? 7Women with type 2 diabetes are less likely to have had screening for diabetes complications in the 12 months before pregnancy; and less likely to have retinal screening in 1st trimester Women with type 2 diabetes less likely to receive contraceptive advice before discharge from hospital after childbirth Z4ZZZ uRecommendations I#ClinicalDuring pregnancy, retinal and renal screening schedules should be provided for both women with type 1 and type 2 diabetes Advice about hypoglycaemia during pregnancy, including prevention and management strategies, should be provided to both women with type 1 and type 2 diabetes > ZZZ vRecommendations II Audit and ResearchDiabetes networks should audit standards of preconception and pregnancy care for both women with type 1 and type 2 diabetes 8~~/+,-./01234rwwd1"(     Chart MSGraph.Chart.80*Microsoft Graph Chart  Chart MSGraph.Chart.80*M ՜.+,0    On-screen ShowCEMACHs  ArialTimes New RomanDefault DesignMicrosoft Graph ChartSlide 1CBackground: Prevalence of type 1 and type 2 diabetes in pregnancy*/Type 1 and type 2 diabetes equivalent risks-Type 2 diabetes differences in ethnicity8Type 2 diabetes differences in social deprivation AimMethodsObesityPlanned pregnancyPreconception folic acid Glycaemic control RetinopathyHypoglycaemiaDifferences in clinical carePost natal care 'Conclusions: clinical characteristics!Are we providing the best care? Recommendations IRecommendations II  Fonts UsedDesign TemplateEmbedded OLE ServersSlide Titles%_Orosie.houstonrosie.houston~~/+,-./01234 0 H@p(  p p 6|“ % ]+A Comparison of type 1 and type 2 diabetes ,,( p 0콓GWu=Dr Bob YoungConsultant DiabetologistHope Hospital, Salford >(2>H p 0޽h ? 3380___PPT10.P@vrWt71