High perinatal mortality and prevalence of congenital anomalies in the offspring of women with diabetes in the UK. Is it time for action?
We have read the article by Macintosh et al with much interest.
Macintosh et al found that the prevalence congenital anomalies and
perinatal mortality in women with diabetes about four times higher than
that of the general maternity population.1 Only 63% of the women with
diabetes had satisfactory HbA1c.1 The results are similar to previous
studies from that showed increased perinatal mortality and congenital
anomalies in the offspring women with diabetes in the UK.2;3
Despite the national service framework (NSF) for diabetes states that
“The NHS will develop, implement and monitor policies that seek to empower
and support women with pre-existing diabetes and those who develop
diabetes during pregnancy to optimize the outcomes of their pregnancy” 4
and 16 years on from saint Vincent declaration 5, perinatal mortality and
congenital abnormalities are still much higher in women with diabetes
compared to the general maternity population.1
The delivery of pre-pregnancy care in women with diabetes is still
poor. The Confidential Enquiry into Maternal and Child Health (CEMACH)
report into Pregnancy in women with type1 and type2 diabetes showed that
only about one third of women with diabetes in England, Wales and Northern
Ireland received pre-conception counselling, had pre-pregnancy glycaemic
control measurement or received folic acid supplements prior to
pregnancy.6 The CEMACH report also showed that only 38% of women managed
to achieve HbA1c less than 7% by 13 weeks of gestation.6
Another important issue is that the number of pregnant women with
type 2 diabetes is on the increase. Pre-gestaional type 2 diabetes
accounted for 27.6% of diabetes in the CEMACH report.6 Women with Type 2
diabetes were more likely to come from ethnic minority origins and
deprived social background and their pre-pregnancy care and pregnancy
outcome are significantly worse than those with type 1 diabetes.7
With the evidence from Macintosh et al of increased adverse outcomes
in the offspring of women with type 2 diabetes and the increasing numbers
of women with type 2 diabetes at childbearing age there is a need for a
more uniformed and structured approach across the UK in order to bring the
perinatal mortality and congenital anomalies in the offspring of women
with diabetes down to that of women without diabetes. The department of
health, general practitioners, obstetricians, diabetes specialists and
other allied professionals should all work together in order to improve
pre-conception care for these patients. A UK-wide approach should be
discussed, in particular how to target the groups with highest risk such
as the Asian community and women from poorer backgrounds.
(1) Macintosh MC, Fleming KM, Bailey JA, Doyle P, Modder J, Acolet D
et al. Perinatal mortality and congenital anomalies in babies of women
with type 1 or type 2 diabetes in England, Wales, and Northern Ireland:
population based study. BMJ 2006; 333(7560):177.
(2) Hawthorne G, Robson S, Ryall EA, Sen D, Roberts SH, Ward Platt
MP. Prospective population based survey of outcome of pregnancy in
diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994.
BMJ 1997; 315(7103):279-281.
(3) Casson IF, Clarke CA, Howard CV, McKendrick O, Pennycook S,
Pharoah PO et al. Outcomes of pregnancy in insulin dependent diabetic
women: results of a five year population cohort study. BMJ 1997;
(4) National Service Framework for Diabetes: Standards. Department
of Health [ 2001 [cited 2006 July 30]; Available from:
(5) Diabetes care and research in Europe: the Saint Vincent
declaration. Diabet Med 1990; 7(4):360.
(6) Confidential Enquiry into Maternal and Child Health. PREGNANCY
IN WOMEN WITH TYPE 1 AND TYPE 2 DIABETES 2002-2003
England, Wales and Northern Ireland Executive Summary. http://www cemach
org uk/publications/Diabetes%20Exec%20summary/Exsum html. [ 2003 [cited
2006 July 30];
(7) Roland JM, Murphy HR, Ball V, Northcote-Wright J, Temple RC. The
pregnancies of women with Type 2 diabetes: poor outcomes but opportunities
for improvement. Diabet Med 2005; 22(12):1774-1777.
Competing interests: No competing interests