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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 mother’s long term health.

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 regularly.

Future Projects

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.

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