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Diabetes and pregnancy preparation: national audit highlights lack of blood sugar control among many pregnant women with diabetes

18 November 2015: More must be done to raise awareness before pregnancy, says audit lead clinician

Three out of four (74 per cent2) pregnant women with diabetes have higher than recommended3 blood sugar4 levels in early pregnancy, new findings from a national audit reveal.

The audit's lead clinician, Dr Nick Lewis-Barned, is now calling for local diabetes teams, general practices and maternity services to work together to help increase awareness among women with diabetes that high blood glucose levels and a lack of preparation for pregnancy can increase the risk of adverse pregnancy outcomes. Such outcomes include stillbirths, neonatal deaths, and babies born with congenital abnormalities.

The National Pregnancy in Diabetes5 (NPID) audit, which is managed by the Health and Social Care Information Centre in partnership with Diabetes UK6 supported by Public Health England, 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 Partnership on behalf of NHS England and the Welsh Government7.

Today's report shows that among 2,537 women with diabetes who were pregnant in 2014 in England, Wales and the Isle of Man:

  • Women with Type 1 diabetes were more likely to have blood glucose levels above the National Institute for Health and Clinical Excellence (NICE) guideline3 in early pregnancy. This was the case for 85 per cent (or 815) of women with Type 1 diabetes and for 64 per cent (or 491) of women with Type 2 diabetes.
  • Almost 12 per cent (112) of women with Type 1 diabetes and eight per cent (62) of women with Type 2 diabetes had blood glucose levels above the level where women are advised to avoid pregnancy8.
  • Just over half of women (51 per cent or 601) with Type 1 diabetes and only one-third (33 per cent or 355) of women with Type 2 diabetes were taking folic acid supplements9 prior to becoming pregnant.
  • One in 10 (11 per cent or 112) women with Type 2 diabetes were taking medication when they became pregnant that can cause harm to the baby10.

As adverse outcomes are relatively rare, the audit report has analysed 2013 and 2014 data together. Women whose baby was born with a congenital abnormality were more likely to have had high blood glucose levels in early pregnancy. Only 17 per cent (23) of women who had babies with congenital abnormalities had blood glucose levels in early pregnancy within the recommended range, compared with 25 per cent (680) of women who had babies with no abnormality that survived for at least 28 days after birth.

The NPID Audit Report 2014 includes data from 150 participating organisations across England, Wales and the Isle of Man. Compared to the first audit in 2013, the number of organisations taking part has increased by 22.

Audit Lead Clinician and advisory group chair, Dr Nick Lewis-Barned said: "There are three key elements of pregnancy preparation for women with diabetes to reduce the risk of adverse pregnancy outcomes - good control of blood glucose levels, taking folic acid supplements and a medication review. It's clear from the audit that many women need more information and more support in all of these areas.

"This means we need to work much more effectively on improving links between policy makers, commissioners, acute trusts, clinical teams, and local general practices and the community to ensure that women get the support they need to have healthy pregnancies."

Read the full report here: http://www.hscic.gov.uk/pubs/npdaudit15


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 260 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. Percentages have been rounded to the nearest whole number.
  3. NICE guidance from February 2015 is that where it is safely achievable without causing problematic hypoglycaemia, women with diabetes who are planning to become pregnant should aim to keep their HbA1c level below 48 mmol/mol (6.5%). (A person's HbA1c level is an average measure of their blood glucose levels over the previous two to three months). The NICE guideline advises that the level of risk for the pregnancy increases with an HbA1c level during pregnancy above 48 mmol/mol. At the time the NPID audit data was collected, the NICE guideline recommended aiming to keep their HbA1c level below 43 mmol/mol (6.1%). This news release reports the percentage of women with an HbA1c level above the 48 mmol/mol recommendation (74 per cent); the audit report gives the percentage of women with an HbA1c level below the 48 mmol/mol recommendation (26 per cent).
  4. Blood sugar levels are the amount of glucose in the blood, commonly referred to as blood glucose. Blood glucose level is the more widely recognised term used by people with diabetes and those who provide diabetes care and support.
  5. 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.
  6. 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 www.diabetes.org.uk.
  7. 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. www.hqip.org.uk.
  8. The NICE guideline recommends that women with diabetes whose HbA1c level is above 86 mmol/mol (10%) are strongly advised not to get pregnant because of the associated risks.
  9. 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.
  10. Women with diabetes have an increased risk of kidney and cardiovascular disease so may be prescribed statins, angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor antagonists. The NICE guideline recommends that women with diabetes should stop taking these drugs before pregnancy, or as soon as pregnancy is confirmed. These drugs have potential to cause fetal harm.
  11. For non-media enquires about the NDA contact enquiries@hscic.gov.uk.
  12. For media enquiries and interview requests please call 0300 303 3888 or contact: media@hscic.gov.uk
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