The challenge

Diabetes in pregnancy is associated with risks to the woman and baby. These can be reduced by good glycaemic control before and during the pregnancy.

Despite the many advances in diabetes and obstetrics care, a women with diabetes is still 2-3 times as likely to have a baby with a congenital abnormality (birth defect) and 5 times as likely to experience a stillbirth than a woman without diabetes. Effective preconception care can reduce these risks to a background level, but nationally only a third of women access this care.

The National Institute for Health and Clinical Excellence lists preconception care as a ‘key priority’ to improving pregnancy outcomes in women with diabetes and has listed preconception as a quality standard for diabetes care. 

How is NHS Diabetes supporting you?

NHS Diabetes has led a programme with the aim of improving care and pregnancy outcomes for women with either pre-existing or gestational diabetes through the various phases of pregnancy. A number of task and finish groups led by experts in the field were established to develop new ideas and initiatives. The work includes:

• A standardised data set (Data Entry Form for the Diabetes in Pregnancy Audit Proof of Concept Project (PDF 468KB)) for evaluating pregnancy outcomes has been developed to inform a national set of standards for the National Diabetes Audit. This data can be used to drive service improvement and support the development of networks.
  
• An integrated care pathway with resources has been developed for the delivery of preconception care to women with Type 1 and Type 2 diabetes. 
  
• A preconception information pack was sent to every diabetes team in England containing leaflets, posters and patient stories to highlight the need for preconception care.
• In collaboration with the Royal College of Midwives standards have been developed (Lead Midwife in Diabetes: Standards, Role and Competencies (PDF 624KB)) for the role and practice of midwives.
• A network has been developed for midwives caring for women with diabetes and includes members from 85% of English trusts with a maternity unit. NHS Diabetes has carried out an evaluation of the member benefits of the network.
• A commissioning guide (PDF 369KB) for diabetes and pregnancy has also been published by NHS Diabetes to support our commissioning process. The guide includes an intervention map detailing all of the elements needed for the service as well as a contracting framework and service specification template. It supports our commissioning approach which offers a step-by-step guide in how to deliver high quality, efficient and cost effective diabetes services.