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New national pregnancy in diabetes audit reveals deficiencies in basic preparation and care

• 'Renewed commitment needed by every diabetes and maternity service' to develop initiatives to reduce pregnancy risk

October 07 2014

The National Pregnancy in Diabetes (NPID) Audit Report 2013 released today has identified that there are improvements needed in pregnancy preparation, care and outcomes for women with diabetes.

The NPID audit, managed by the Health and Social Care Information Centre in partnership with Diabetes UK supported by Public Health England, is the first continuous national audit5 that measures the implementation of national guidance on the care of women with diabetes who become pregnant. It forms part of the National Clinical Audit programme, commissioned by the Healthcare Quality Improvement Partnership3.

Women with diabetes are at higher risk of adverse pregnancy outcomes such as stillbirths, neonatal deaths and babies born with congenital anomalies. They are also likely to have larger babies.

Managing blood glucose is one of the main ways to minimise the risk of these outcomes. Glucose levels should be monitored as part of pregnancy preparation and throughout the pregnancy6.

One of the key findings was that only five per cent of women with Type 1 diabetes and 19 per cent of women with Type 2 diabetes achieved the target blood glucose readings for early pregnancy set out in national guidelines6.

The NPID Audit Report 2013 includes data collected from 1,700 pregnancies across 128 participating organisations across England and Wales. The key findings also show:

  • Only 40 per cent of women with diabetes were taking folic acid supplements prior to pregnancy7, folic acid use was highest among women with Type 1 diabetes.
  • Almost half (46 per cent) of women with Type 1 diabetes and almost one quarter (23 per cent) of women with Type 2 diabetes had a baby that was large for the length of pregnancy (i.e. with weight in the top 10 per cent of all birth weights for pregnancies of that length).
  • Almost one in 10 women with Type 2 diabetes (9 per cent) were taking blood glucose medications that may be harmful in pregnancy at the time they became pregnant8.
  • Three out of 10 babies required intensive or specialist neonatal care, in a 2002/3 survey5 there were nearly twice as many babies requiring this care (57 per cent)9.

Audit Lead Clinician and advisory group chair, Dr Nick Lewis-Barned said: "For the first time we are able to measure how the national guidance around pregnancy management in women with diabetes, which was produced in response to the CEMACH report in 2005, is working throughout England and Wales.

"It is encouraging that some aspects of pregnancy preparation and care have improved to some extent since then, but this audit has also highlighted that this progress is at best modest.

"The majority of women with diabetes in England and Wales enter pregnancy with avoidable increased risk, and many have unsatisfactory glucose control during pregnancy. This puts their fetus and themselves at further risk. Improving this will require collaboration between local service providers across public health, primary and specialist care and a clear plan for change.

"Every diabetes healthcare community and maternity service needs to respond by developing local improvement initiatives to reduce pregnancy risk."

Read the report here:


Notes to editors

  1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.
  2. Diabetes UK is the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by and at risk of diabetes. For more information visit
  3. About HQIP, the National Clinical Audit Programme and how it is funded: The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.
  4. The NPID audit is part of the National Diabetes Audit (NDA) programme and is managed by the Health and Social Care Information Centre (HSCIC), in partnership with Diabetes UK and is supported by Public Health England. The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme. An advisory group consisting of physicians, obstetricians, midwives, public health physicians, service users, Diabetes UK and members of the HSCIC team provide support and direction to the audit.
  5. The Confidential Enquiry into Maternal and Child Health (CEMACH) completed a descriptive study of pregnancies in women with diabetes in 2002-3 that was published in 2005.(Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002-03, England, Wales and Northern Ireland. London: CEMACH; 2005.) The CEMACH report identified critical deficiencies in preparation for pregnancy in women with diabetes, care during pregnancy and outcomes.
  6. NICE guidance is that where it is safely achievable, women with diabetes who are planning to become pregnant should maintain their HbA1c below 43 mmol/mol (6.1%). (A  person's HbA1c value is an average measure of their blood glucose levels over the previous 2 to 3 months).
  7. Women with diabetes have an increased risk of having a pregnancy affected by a neural tube defect. NICE guidance is that women with diabetes who are planning to become pregnant should be advised to take 5 milligrams (5mg) of folic acid daily until 12 weeks of gestation to reduce this risk.
  8. The only medications known to be safe in pregnancy are insulin and metformin.
  9. The NICE guideline states that babies of women with diabetes should be kept with their mothers unless intensive or special care is clinically necessary. The 2013 NPID audit reports that 70 per cent of babies received normal post natal care with their mothers. 43 per cent of babies in the CEMACH5 survey received this level of care.
  10. Numbers above 1000 have been rounded to the nearest 10; percentages have been rounded to the nearest whole number.
  11. For non-media enquires about the NDA contact
  12. For media enquiries and interview requests please call 0300 303 3888 or contact:
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