Pre pregnancy counselling
and good pre pregnancy diabetic control is the only
way of reducing the miscarriage and congenital abnormality
rate in diabetics to that of the background population.
In addition it may help reduce the stillbirth rate,
fetal macrosomia and the sequelae of birth trauma,
fetal hypoglycaemia, hypocalcaemia and polycythaemia.
Every opportunity must be taken to inform all women
of childbearing age of the risks of a diabetic pregnancy
and what can be done to minimise those risks.
Clinicians should be more aware of the harmful effects
of Type 2 as well as Type 1 diabetes in pregnancy.
It should not be regarded as less severe and the outcomes
such as miscarriage, congenital malformations, delivery
prior to 37 weeks and macrosomia may be worse than
for type 1 diabetics. In addition pregnancy should
be seen as an ideal opportunity to reinforce the importance
of good diabetic control for the mothers long
All pregnant women with diabetes should be managed
in a joint diabetic antenatal clinic with a named obstetrician,
physician, midwife specialist and diabetic nurse specialist
working together to agreed standards, which are audited
Pre-existing diabetes in pregnancy is the subject
of the latest CESDI enquiry. It will specifically look
at women with pre-existing type 1 and type 2 diabetes
and will include the collection of data concerning
the full range of care, from pre-conception to 28 days
following delivery. This will provide essential denominator
data on all diabetic pregnancies in England, Wales
and Northern Ireland during 2002.
It will examine in more depth certain subgroups within
this group, such as those pregnancies that result in
a perinatal death. The programme will highlight areas
of maternity and neonatal care which may be improved.
A three month pilot study is currently underway in
all units regionally and nationally.