A SURVEY OF UK DIABETIC PREGNANCY MANAGEMENT

The provision of care and current management strategies for diabetic pregnancy in the United Kingdom were assessed by canvassing British diabetologists. Questionnaires were sent to 376 Consultant Physicians known to have an interest in diabetes, in 239 Health Districts. The response rate was 52% providing information from 182 (76%) Districts. In 66 (36 %) Districts, there was an existing combined diabetes/obstetric clinic, with median annual caseloads of 13 (range 1-200) patients. Preconception counselling was offered in 22 clinics. In 153 (84 %) of the clinics, the standard WHO diagnostic criteria for diabetes were applied to pregnant patients and 149 (97 %) of the clinics using WHO criteria treated patients with 'Impaired Glucose Tolerance' as if they were overtly diabetic. Reflectance meters for home monitoring were employed in 119 (65 %) clinics. Target premeal blood glucose values were less-than-or-equal-to 6.0 (range 3.0-12.0) mmol l-1 (n = 172) and post-meal less-than-or-equal-to 8.0 (5.0-10.5) mmol l-1 (n = 139). Insulin was introduced when blood glucose values exceeded 7.0 (5.0-12.0) mmol l-1 (n = 162) pre-meal or 9.0 (5.5-15.0) mmol l-1 (n = 129) post-meal. No unit used oral hypoglycaemic agents during pregnancy. Sixty percent of respondents were unable to provide accurate fetal loss/perinatal mortality rates, usually due to lack of recorded data. Where data were available, fetal loss was almost always intra-uterine. Only 78 (43%) centres allowed pregnancy to progress to term. The caesarean section rate for diabetic women was 35 (8-90) % (n = 111), compared with stated rates of 12 (7-20) % (n = 102) for non-diabetic women. Routine hospital admission for the final weeks of pregnancy was advocated in 23 (13 %) centres.