An audit of the care and outcome of pregnancies complicated by diabetes at the Leeds teaching hospitals NHS trust

Abstract

Background Around 2-5% of births in England and Wales each year involve women with diabetes (pre-gestational and gestational). This is associated with a number of complications for both mother and baby.1 Aims To audit antenatal care and outcomes of pregnancies complicated by diabetes in the Leeds Teaching Hospitals NHS Trust using standards taken from the NICE guideline ‘Diabetes in Pregnancy’.1 Methods Prospective and retrospective data collection from case-notes of women with pregnancies complicated by diabetes delivering in the Leeds Teaching Hospital Trust during 2010. Results Of 208 patients audited, 43 had pre-existing diabetes while 165 had GDM. There was relatively low attendance at pre-conception clinic (37% type 1, 14% type 2), although there was no difference in HbA1c of those attending (7.7% vs 7.8%). Patients attending the pre-conception clinic were more likely to take the recommended folic acid dose (88% vs 40%). 77% of gestational and 44% of pre-existing diabetics delivered ≥38 weeks. When considering mode of delivery 62% of those with GDM and 48% of those with type 1 diabetes delivered vaginally. However, a significantly increased caesarean section rate in type 2 diabetes was noted (>80%). An increase in obstetric complications was also noted with 20% suffering from pre-eclampsia and a higher incidence of post partum haemorrhage was also seen. Conclusions Although many aspects of antenatal care in these women met audit standards, improvements are needed. The significantly higher caesarean section rate in type 2 diabetics may be related to increased age and BMI in this group.