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Preconception services should be audited to ensure that minimum standards are being met. ZP@Recommendations II Minimum standards for preconception services Clear signposting to different aspects of careDiet and lifestyle adviceProvision of appropriate contraceptionHigher dose folic acid supplementationSmoking cessation supportAssessment and management of diabetes complicationsh/Z/ZZZ./QARecommendations III Minimum standards for preconception services Setting of glycaemic control targets and regular discussion of results of self-monitoring, to enable the woman to achieve control that is as near to normal as possible before conception Discussion of diabetes pregnancy risks and expected management strategies Clear documentation of care and counselling, ideally using a standard templateB.PXP-WRBThe Challenge  Organisation of servicesHow to deliver advice on risk sensitivelyHow to guide women through the disruption of  alterations to care /S T UVW   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@|?" dd@   " @ ` n?" dd@   @@``PV    @ ` `p>>  N(    6̛ ,  T Click to edit Master title style! !  0 'g  RClick to edit Master text stylesSecond levelThird levelFourth levelFifth level!   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R$`jǪ<"D@G $$$"$&u,UW !0}%"$n==a?^ 0AA@8wR ʚ; f8ʚ;g4BdBdhx: 0(ppp@ <4dddd  0T<<4!d!d  0T< 80___PPT10pp  D4Why preconception care?#JMinimise the risk of fetal congenital anomalies Optimise glycaemic controlCommence higher dose (5mg) folic acidGive informationRisks and management strategies Ensure that women enter pregnancy in the best possible healthScreen for diabetes complications Review medicationEmpower women to plan and prepare for pregnancy 1PAPP!P>P5P0PP/A!>50E5Previous findings17% of units in England, Wales and Northern Ireland provided a structured multidisciplinary preconception service CEMACH Survey of diabetes maternity services 2004 35% of women had pre-pregnancy counselling37% of women had a test of glycaemic control in the 6 months before conception39% of women commenced folic acid before pregnancy CEMACH: Pregnancy in women with type 1 and type 2 diabetes in 2002-2003rP6PPOPr1KF6BMethod used to obtain information relating to preconception periodCCPre-pregnancy pro formaRelated to the 12 months before pregnancyPro forma sent to adult diabetes service and general practitioner for each womanMissing data for specific data items ranged from <5% to >50%ZG7ADiscussion of specific issues in the 12 months prior to pregnancyBBH8rProportion of women having a retinal examination and renal function test in the 12 months before pregnancy (n=382)ssI9<Preconception factors associated with poor pregnancy outcome==J:/Issues underlying suboptimal preconception care00Opportunity not taken by health professional to give preconception adviceFolic acid not advised/prescribed by health professionalsPoor screening/management of diabetes complications *K;DTest of glycaemic control in the 12 months before pregnancy (N=379)EEL<Targets and glycaemic control28% of 369 women had evidence of glycaemic control targets set before pregnancy 79% of 354 women were assessed by panels to have suboptimal preconception glycaemic control Suboptimal preconception glycaemic control was associated with poor pregnancy outcome (OR 3.9, 95% CI 2.2 - 7.0)ZM=<Issues underlying suboptimal preconception glycaemic control==Mainly social and lifestyle issuesClinical care issues:Lack of timely input to improve glycaemic controlInadequate insulin regime advisedPoor follow-up of non-attenders &9v9vN> ConclusionsSuboptimal clinical support and information givingProblems with diabetes review in the 12 months before pregnancy:57% of women had a test of glycaemic control 59% had a retinal examination58% had a test of renal functionPoor documentation of counselling and care given to women<tm;tm;O?Recommendations ICommissioners of services must ensure that all women with diabetes are provided with specialist preconception services, with access to all members of the specialist multidisciplinary team. Preconception services should be audited to ensure that minimum standards are being met. ZP@Recommendations II Minimum standards for preconception services Clear signposting to different aspects of careDiet and lifestyle adviceProvision of appropriate contraceptionHigher dose folic acid supplementationSmoking cessation supportAssessment and management of diabetes complicationsh/Z/ZZZ./QARecommendations III Minimum standards for preconception services Setting of glycaemic control targets and regular discussion of results of self-monitoring, to enable the woman to achieve control that is as near to normal as possible before conception Discussion of diabetes pregnancy risks and expected management strategies Clear documentation of care and counselling, ideally using a standard templateB.PXP-WRBThe Challenge  Organisation of servicesHow to deliver advice on risk sensitivelyHow to guide women through the disruption of  alterations to care /S T UVW   0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғ3y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@|?" dd@   " @ ` n?" dd@   @@``PV    @ ` `p>>  N(    6 ,  T Click to edit Master title style! !  0, 'g  RClick to edit Master text stylesSecond levelThird levelFourth levelFifth level!   S`  C *APicture1"   0 Y&  TCEMACH Diabetes in Pregnancy National Report Launch, Sheffield, 26th February 2007UU   nAL Y?$dv418111ucPreview_imgMain#" `SH  0޽h ? 3380___PPT10.O2 Default Designr  z#iz1 ՜.+,0   -On-screen ShowCEMACH ArialTimes New RomanDefault DesignMicrosoft Graph ChartSlide 1Why preconception care?Previous findingsCMethod used to obtain information relating to preconception periodBDiscussion of specific issues in the 12 months prior to pregnancysProportion of women having a retinal examination and renal function test in the 12 months before pregnancy (n=382)=Preconception factors associated with poor pregnancy outcome0Issues underlying suboptimal preconception careETest of glycaemic control in the 12 months before pregnancy (N=379)Targets and glycaemic control=Issues underlying suboptimal preconception glycaemic control ConclusionsRecommendations IRecommendations IIRecommendations IIIThe Challenge  Fonts UsedDesign TemplateEmbedded OLE ServersSlide Titles%_ӧrosie.houstonrosie.houston