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At the heart of general practice since 1960

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Women with diabetes are being poorly prepared for pregnancy despite high rates of stillbirth and congenital malformation, a landmark report concludes.

The Confidential Enquiry into Maternal and Child Health warned women with type 2 diabetes were particularly likely to miss out on prepregnancy counselling and treatment, despite comparable risks to those with type 1.

The enquiry urged GPs to be vigilant in identifying women considering pregnancy, offering them counselling and treatment and referring them after conception (see box, below).

The enquiry examined 3,808 pregnancies in women with diabetes in England, Wales and Northern Ireland in 2002/03, and found there were 29.2 stillbirths per 1,000 births with type 2 diabetes and 25.8 with type 1.

Just 25 per cent of women with type 2 diabetes had received prepregnancy counselling but 38 per cent with type 1. Only 29 per cent with type 2 had a record of a prepregnancy glycaemic test, compared with 40 per cent with type 1.

Women with type 2 diabetes were also less likely to be taking high-dose folic acid supplements than those with type 1, the enquiry found.

Dr Mary Macintosh, medical director of the enquiry, said: ‘We are particularly concerned at what we have found in type 2 diabetes in pregnancy.

‘It's important women get advice about planning pregnancy. There's an assumption type 2 diabetes is more benign. We need more education.'

Preparing diabetes patients for pregnancy

•Bring up possibility of pregnancy in consultations

•Offer pre-conception counselling including advice on controlling blood glucose before conception

•Carry out prepregnancy glycaemic test

•Prescribe high-dose folic acid supplements

•Refer promptly for scan in first trimester

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