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Babies at risk from mothers’ diabetes

18 June, 2008

Babies at risk from mothers’ diabetes

A study of diabetes and pregnancy has revealed a need for greater awareness about the issue. Midwives and other health professionals are well-placed to help mothers with the condition, as John Camm reports.

Midwives magazine: November 2005


A study of diabetes and pregnancy has revealed a need for greater awareness about the issue. Midwives and other health professionals are well-placed to help mothers with the condition, as John Camm reports.


Babies of women with diabetes are nearly five times as likely to be stillborn as those without the condition, and nearly three times as likely to die in their first month of life, according to the largest study of diabetes in pregnancy to date.


The report Pregnancy in women with type 1 and type 2 diabetes, 2002 to 2003 was carried out by the Confidential Enquiry into Maternal and Child Health (CEMACH). It aims to improve the health of mothers, babies and children by carrying out research and publishing recommendations.


The report found that of 2356 babies born to mothers with diabetes between 1 March 2002 and 28 February 2003, there were 63 stillbirths and a further 22 who died before they were one month old. The document also shows that major congenital malformations were twice as likely in babies with diabetic mothers. The report outlines how pregnant women with diabetes can reduce the risk to their babies.


At present, pregnant women with diabetes can expect support in getting the best blood sugar control, regular kidney and eye checks, a scan before 14 weeks and blood pressure checks. However, the study concludes that more action is necessary, including:

  • Preparing in advance for pregnancy with healthcare professionals

  • Measuring and maintaining good control over blood sugar levels before and during pregnancy

  • Taking 5mg of folic acid before pregnancy until the 12th week

  • Receiving antenatal care as early as possible.


The CEMACH report also highlights the problem of type 2 diabetes that accounted for 27% of the cases of diabetes in the study. Type 2 diabetes usually occurs in middle-aged people, especially if they are overweight, but it is becoming more common in younger people.


Medical director of CEMACH Dr Mary Macintosh said: ‘We are particularly concerned at what we have found about type 2 diabetes in pregnancy. The evidence is that type 2 diabetes is becoming more common and, contrary to what many people have believed, it is just as likely to lead to a baby’s death or a malformation as if the mother has type 1 diabetes.’


The study also found that certain groups of women were more at risk. Half the women with type 2 diabetes were from ethnic minority populations, and almost half lived in a deprived area. Previous studies have suggested that type 2 diabetes is strongly associated with obesity and physically inactive lifestyles. Women with type 2 diabetes in the CEMACH study were also poorly prepared for pregnancy. They were unlikely to have had counselling before conceiving, had low levels of blood sugar testing prior to pregnancy and low use of folic acid supplements.


Consultant obstetrician at University College London Hospitals NHS Foundation Trust and obstetrics lead at CEMACH Dr Jo Modder said both the public and health professionals need to be more aware of diabetes in pregnancy, and that midwives have an important role to play: ‘There are a number of things that midwives are well placed to do. They are, in a way, the link between the community and secondary care.’ Midwives also have a large role to play in supporting pregnant women with diabetes who require more frequent visits to antenatal clinics, scans and blood sugar tests, and have to give themselves insulin injections.


As Dr Modder puts it, ‘It’s a very interventionist pregnancy.’ She is also concerned about the report’s findings that in the high-risk groups only half the women intended to breastfeed and that midwives have an opportunity to intervene and encourage more to do so. They also need to be aware of type 2 diabetes that can be harder to detect because people who develop type 1 often become very ill quite quickly – this is less likely to happen with type 2. Dr Modder said: ‘If you’re not being tested, you might not have known about it for many years.’


CEMACH is helping to produce a leaflet of best practice and Dr Modder says she would like to see more education about diabetes and pregnancy, possibly taking place in maternity units. ‘I think that one thing that could be done is that local organisations need to have a teaching session.’ She said that having identified high-risk groups, it was possible to start trying to raise awareness, for example, by talking to women in the community, as one of her consultant midwife colleagues was doing. Another opportunity was to use diabetes registers to identify women at risk. She said: ‘All people with diabetes should be registered. That provides an opportunity to target women of childbearing age.’


Other organisations echoed CEMACH’s concerns. Chief executive of Diabetes UK Douglas Smallwood said: ‘We have known about the risks to babies of women with diabetes for a long time. Sadly it appears we are making little progress in tackling the problem.Women with diabetes need to be made fully aware of the risks before they become pregnant. Then those looking after them need to ensure that all the right steps are being taken to allow women to effectively reduce those risks. With advances in what we know about the risks and what we can do about them, it is unacceptable that women are losing their babies unnecessarily.’


Further information


To read the full report, please visit: www.cemach.org.uk For further information about diabetes, please visit the Diabetes UK website at: www.diabetes.org.uk or visit: www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCare Topics/Diabetes/fs/en for information about the National Service Framework for diabetes.







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