Good preparation for pregnancy in women with diabetes is well recognised to improve outcomes for mother and baby. So it is with some concern that we read in the recent National Diabetes in Pregnancy (NPID) report 2015 that only 46% of women with Type 1 and 23% with Type 2 were even taking recommended 5mg folic acid prior to conception. Rather fewer had good glycaemic control by current recommended targets, just 16% of Type 1 and 38% of women with Type 2 diabetes. Although that leaves considerable room for improvement, there is some good news, with stillbirth rates falling by more than 50% over the past 12 years, although still double that of the general population and sadly neonatal deaths still well above that expected.
The first step is understanding what we are struggling to achieve with current medical practice and this audit of more than 3000 women highlights areas where we can improve. Achieving good glycaemic control is a considerable challenge for some, but some targets such as ensuring women with diabetes have adequate contraceptive advice, if seeking pregnancy are on folic acid 5mg and at least in regular contact with their diabetes healthcare team are likely more easily achieved.
The challenge is there; encompassing primary and secondary healthcare services, as well as public health awareness and particularly women with diabetes themselves. See HERE:
