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Opinion Volume 9 Issue 6
Is the care for pregnant women with diabetes as good as it should be? a result of an audit on the care of women with gestational diabetes
Fadimatu Aliya Umaru,1
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Andrew Muotune2
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1Speciality Trainee, Obstetrics and Gynaecology, Bolton Hospital NHS Foundation Trust, UK
2Consultant, Obstetrics and Gynaecology, Bolton Hospital NHS Foundation Trust, UK
Correspondence: Fadimatu Aliya Umaru, Speciality Trainee, Obstetrics and Gynaecology, Bolton Hospital NHS Foundation Trust, Bolton, UK
Received: June 06, 2017 | Published: November 15, 2018
Citation: Mahomed K, Stanton M. Is the care for pregnant women with diabetes as good as it should be? a result of an audit on the care of women with gestational diabetes. Obstet Gynecol Int J. 2018;9(6):395. DOI: 10.15406/ogij.2018.09.00373
Abstract
Gestational diabetes (GDM) is the most common medical disorder in pregnancy.1 Pregnant women with this condition and their babies have increased risks in the antenatal, intrapartum and post-natal period and it also an impact on long term health.2 It is important to use a multi-disciplinary approach when caring for these patients to ensure the best outcomes.3
Background
GDM affects 2-5% of pregnant women.3. Some risk factors for GDM include BM1 > 30kg/m², previous gestational diabetes, family history of diabetes (first-degree relative with diabetes), family origin with a high prevalence of diabetes: South Asian, Black Caribbean, Middle Eastern and previous macrosomic baby weighing 4.5kg or more.2,3 There are also many complications of GDM including recurrent Urinary Tract Iinfections, pyelonephritis, pre eclampsia, polyhydramnios, placental abruption, preterm labour, increased risk of C/S and IOL, post partum haemorrhage, macrosomia; shoulder dystocia, neonatal hypoglycemia, respiratory distress and still birth.1,2 There is also a risk of mum and baby developing type 2 diabetes.4 It is therefore important to optimise the care of women with diabetes in pregnancy. This audit aims to highlight how well the unit is performing with the care of pregnant women with GDM against the National Institute of Clinical Excellence (NICE) guidelines and local trust guidelines.
Methodology
All deliveries between a six month periods were retrospectively analysed. There were a total of 3411 deliveries (3442 babies). The total number of women with diabetes was 101. 45 had pre existing diabetes and 56 (1.6%) had GDM. 34 of those notes were analysed.
Results
The audit shows that in 55% of cases there was one clinical indication for performing a Glucose Tolerance Test. In 30% of cases, there were two indications and in 15% there were three indications. The most common indication for performing a GTT was family history and ethnic background. 67% of patients had a BMI of less than 30, 17% between 30 and 35, and 16% BMI more than 35. 43% of women were managed with dietary advice, 30% with insulin, 17% with metformin, 10% with metformin and insulin. As part of the antenatal care, 50% had 4 growth scans in pregnancy, the minimum number of growth scans offered was 2 and the maximum was 7 scans to assess fetal wellbeing. 47% had IOL. 15% had assisted vaginal delivery. In labour, 69% were not given a sliding scale, 31% had a sliding scale. There was an overall complication rate of 53% some of which include polyhadramnios, prolonged second stage, second degree tear, pre-eclampsia, retained placenta, placental abruption, post partum haemorrhage, and emergency caesarean section. There was no case of still birth, shoulder dystocia or third or fourth degree perineal tear. Incidence of NICU admission was 10%.
Conclusion
The care of pregnant women with GDM is an important aspect of delivering good quality antenatal care as these women are a high risk group. With the many complications of GDM, it is vital to have a good multidisciplinary team approach to ensure that their care from conception to the post delivery period is well delivered. The results of the audit show that our unit is meeting most of the targets outlined by NICE and local policies. An area for improvement is to ensure that the proformas for GDM are used more consistently, and that women get referred for glucose tolerance testing 6 weeks post delivery as per guidelines.
Acknowledgements
None.
Conflict of interest
The authors declare that they have no conflict of interest.
References
- Black RS, Gillmer MD. Diabetes in pregnancy. The Obstetrician & Gynaecologist. 2003;5(3):143–148.
- Gillmer MDG, Hurley PA. Diabetes and endocrine disorders in pregnancy. In: Edmonds DK, editor. Dewhunt’s Textbook of Obstetrics and Gynaecology for Postgraduates. 6th ed. Oxford Blackwell Science; 1999:197−209.
- National Institute of Clinical Excellence Guidelines (NICE NG3). Diabetes in pregnancy: management from preconception to the postnatal period. 2015.
- Nelson-Piercy C. Handbook of Obstetric Medicine. 2nd ed. London: Martin Dunitz; 2001:82−99.
©2018 Mahomed, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.