Despite clinical guidelines and agreement about the importance of pre-pregnancy planning in women with diabetes, very few women are achieving the tight control needed in early pregnancy to reduce risk of adverse outcomes, Professor Helen Murphy from the University of East Anglia in the UK told delegates at the ADS-ADEA Annual Scientific Meeting on Wednesday.

“Although we know what is needed, we are struggling to deliver”, she said.

Professor Murphy presented data from the UK National Pregnancy in Diabetes (NPID) audit (including 2,537 diabetes pregnancies in women who delivered during 2014, 52% with type 1 and 47% with type 2 diabetes) showing that only 15% women with type 1 and 36% with type 2 diabetes achieved target HbA1c levels (<48mmol/mol or 6.5%) in early pregnancy.

Only half (51%) of the women with type 1 and one-third of the women with type 2 took preconception folic acid, and 10% of those with type 2 were taking potentially harmful medications at the time of conception (including oral hypoglycaemic agents, statins, ACE inhibitors and ARBs).

She also presented some of her own research findings, showing that women who attend pre-pregnancy care have tighter glycaemic control, and those without pre-pregnancy care don’t reach the same level of glycaemic control, even by the third trimester.

Pre-pregnancy care was a stronger predictor of pregnancy outcome than maternal obesity, ethnicity, or social disadvantage.

For busy health professionals, it can be easy to overlook the topic of pre-pregnancy care, particularly within short consultations where there are other priorities. However it is clearly an area that needs prioritisation.

In particular, Professor Murphy highlighted the need to more effectively engage the “in-betweeners” – those who are not actively seeking pregnancy but also not specifically avoiding it.

Healthcare professionals also needed to be more aware of a woman’s reproductive potential, particularly those with type 2, who are less likely to seek pre-pregnancy care.

What do women want?

When it comes to education, Professor Murphy highlighted the need to balance ‘health reassuring’ and ‘health alarming’ messages. “If it’s too alarming or too reassuring, women are less likely to engage”, she explained.

In her work with women with diabetes, they reported wanting:

• Pre-pregnancy care delivered locally, with access to specialist care.
• Verbal communication in addition to written, with a healthcare provider they trust and have a good relationship with.
• To be told about PPC at diagnosis and reminded regularly thereafter but not too much and not at every visit.
• For those with type 1, practical information re sex/hypo avoidance and contraception, and not all about babies, or as one woman put it, “how to avoid biscuit crumbs in the bed after sex”.