How often do we ask about pregnancy in the diabetes review clinic?

Sub-optimal control of diabetes is a significant cause of complications during pregnancy. One of the aims of diabetes management should be to ensure that all women of child-bearing age with diabetes should be regularly screened with regard to their plans for pregnancy to ensure that their overall diabetic control and fitness for pregnancy can be maximized.

We analysed the electronic patient records of a target population of young women of child-bearing age (16-45) with both type 1 and type 2 diabetes who were attending the diabetes review clinic over a period of three years from 2007 to 2010. The Diabeta 3 software program which is commonly used has a query builder function which allows immediate recall and analysis of data.

Of 1808 patients within the fertile range, only a small number appeared to have had information accurately documented with regard to any of the following: pregnancy plans, preconception counselling, contraception and also the recording of whether patients with diabetes were pregnant or not and enrolled in the ante-natal diabetes clinic.

The main inference from the data is its paucity and inaccuracy. It would appear that we are failing to enquire and/or record the fertility intentions of young female patients with diabetes. This is important because it means that we subsequently then miss those patients who need to be targeted for preconception counselling/optimization, which has implications for the morbidity and mortality associated with diabetes in pregnancy.