Women with diabetes are poorly prepared for pregnancy

New research has shown the majority of women with diabetes in England and Wales have excessively high blood sugar during their pregnancy.

These high blood sugar levels can contribute to an increase of stillbirth, newborn deaths and birth defects. The National Pregnancy in Diabetes audit looked at 2,357 pregnant women with diabetes across England and Wales in 2014.

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Credit to Il-Young Ko

The researchers measured how much the women’s pregnancy care matched up to recommended guidance. They concluded: “women generally enter pregnancy poorly prepared and outcomes have changed little since 2002-3.”

This poor preparation was not limited to high blood sugars. Half of those with Type 1 diabetes, and one third of those with Type 2, did not take folic acid supplements before conceiving as recommended.

Credit to Mike Mozart
Credit to Mike Mozart

Folic acid prevents spina bifida – a spinal problem beginning early in pregnancy and can cause lifelong disability. It must be taken early on in pregnancy to have an effect.

One in ten women with Type 2 diabetes were taking medications, such as statins, which can be harmful to unborn babies.

Women with Type 2 diabetes are recommended to swap their standard medications for insulin during pregnancy. Insulin, unlike most other medications that lower blood sugar, does not cause side-effects in unborn babies.

Referring to high blood sugars, folic acid and medications, lead researcher Dr Nick Lewis-Barned said: “it’s clear from the audit, many women need more information and more support in all of these areas.”

The research gives several recommendations for women with diabetes to make sure they have the safest possible pregnancy, including:

  • To use safe, effective contraception if not trying for a child
  • To seek pre-pregnancy advice before trying
  • To ask for folic acid supplements on prescription, and ask for monthly blood sugar measurements
  • To access specialist services as soon as pregnancy is suspected

Dr Lewis-Barned emphasised these findings were not a criticism of women with diabetes. Instead he stressed they were an opportunity for an improvement in care: “we need to work much more effectively on improving links between clinical teams, local general practices and the community to ensure women get the support they need to have healthy pregnancies.”

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