Pregnancy in Diabetes: challenges and opportunities for improving pregnancy outcomes.

Our aim was to review the data from the National Pregnancy in Diabetes (NPID) audit, and to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. We reviewed three years of NPID data and relevant diabetes and obstetric literature, and found that there has been little change in pregnancy preparation or outcomes over the past 3 years, with substantial clinic-to clinic variations in care. Women with Type 2 diabetes remain less likely to take 5 mg preconception folic acid (22.8% vs. 41.8%; P < 0.05), and more likely to take potentially harmful medications (statin and/or ACE inhibitor 13.0% vs. 1.8%; P < 0.05) than women with Type 1 diabetes. However, women with Type 1 diabetes are less likely to achieve the recommended glucose control target of HbA1c < 48 mmol/mol (6.5%) (14.9% vs. 38.1%; P < 0.05). The following opportunities for improvement were identified. First, the need to integrate reproductive health into the diabetes care plans of all women with diabetes aged 15-50 years. Second, to develop more innovative approaches to improve uptake of pre-pregnancy care in women with Type 2 diabetes in primary care settings. Third, to integrate insulin pump, continuous glucose monitoring and automated insulin delivery technologies into the pre-pregnancy and antenatal care of women with Type 1 diabetes. Fourth, to improve postnatal care with personalized approaches targeting women with previous pregnancy loss, congenital anomaly and perinatal mortality. A nationwide commitment to delivering integrated reproductive and diabetes healthcare interventions is needed to improve the health outcomes of women with diabetes.

[Do we need new guidelines on iron supplementation during pregnancy?]. / Trenger vi nye retningslinjer for bruk av jerntilskudd i svangerskapet?

Studies have shown that the present official Norwegian recommendations on iron supplementation during pregnancy are not followed. A meeting was arranged in February 1993 to discuss the need to change the recommendations. The article describes the conclusions of the panel. It was proposed that the iron status of the pregnant woman, determined as serum ferritin concentration, should be measured early (before the 15th week of gestation) and iron supplement should be given as selective prophylaxis based on the serum ferritin level. The Directorate of Public Health has been asked to issue new recommendations.

[Pregnancy and iron supplementation--are the official guidelines followed?]. / Graviditet og jerntilskudd--blir de offisielle retningslinjene fulgt?

In the present study we have examined to what extent the national recommendations concerning iron supplements during pregnancy are being followed. 222 women in childbed were interviewed within one week after delivery concerning their intake of iron and other dietary supplements. We found that no more than 1/4 of the women were using iron supplements according to the national recommendations and that the advice given by doctors, midwives or public health nurses varied considerably. 70% of the women were recommended to take iron supplement, but no more than 66% of them were given specific advice as to which iron preparation they should take, or in what doses. The specific advice that was given varied. 93% of the women who were advised to take iron supplement followed this advice. More women took low-dose iron preparations, while more doctors recommended high-dose preparations. Only 30% of the women thought that iron supplement is vital for all pregnant women. We also found that many of the women (59%) took one or more dietary supplements, alone or in addition to iron.