In the UK, diabetes is still the most common cause of blindness in the working population. 20-25% of patients entering end-stage renal failure replacement programmes have diabetes. The health commission reported that, there are almost two million people who are undiagnosed diabetics and the majority are women. Many people have diabetes for several years before it is diagnosed. (Daily Post, 2006, p. 17) Pregnancy in women with diabetes has a poorer outcome for the foetus than a non-diabetic pregnancy. (Diabetes, 2006)
Approximately 6.4% of all pregnancies are complicated by diabetes in UK excluding those 1.9% pregnancies where the mother had insulin-dependent and gestational diabetes. (Lowy et al) The majority (90%) of diabetics in UK are gestational diabetics defined as onset or recognition of abnormal carbohydrate metabolism during pregnancy. Type 1 diabetes is characterised by pancreatic beta cell dysfunction with a resultant lack of insulin production requiring exogenous insulin therapy as a mainstay of treatment as well as dietary management. The average age of diagnosis for type 1 in UK women is less than 30. Type 2 diabetes is usually diagnosed at greater than 40 years of age, so this type of diabetes is not encountered as frequently in pregnancy, although it is by far the most prevalent type of diabetes nationwide. (Kendrick, 1999, p. 224)
The risk for adverse pregnancy outcome in UK women with diabetes h...
According to Howell et al, "The benefit of folic acid is a simple health promotion message of proven effectiveness that is particularly pertinent to a young population with a high birth rate". (Howell, 2001) In spite of advances in the gestational health care, pregnancies are complicated by diabetes, whereas foetal and neonatal mortality remains at 2-4%. (Lisa & Nan, 1999) The major cause of perinatal mortality with diabetes can be attributed to congenital malformations and unexplained foetal death. Congenital malformations account for approximately 40% of perinatal deaths in diabetes with no specific associated malformation. The congenital malformations associated with diabetes are usually multiple, more severe, and more often fatal than birth defects found in offspring of nondiabetic women. As early maternal hyperglycemia is associated with a higher incidence of congenital malformations therefore, the incidence of babies with birth defects born to mothers with diabetes increase the rate significantly with preconception control as evidenced by lower glycosylated hemoglobin levels at the time of organogenesis. (Lisa & Nan, 1999)
Pre-conceptual and ante-natal Educational Programs
Ideally women with pre existing diabetes should have planned pregnancies for preconceptual assessment, counselling and management. However only 20% of diabetic women seek prepregnancy care. This is not unusual considering that approximately 60% of all pregnancies are unintended. The primary goal of preconception care is to improve the metabolic profile before conception and throughout the early weeks of pregnancy to decrease the risk of first trimester spontaneous abortion and major congenital anamolies. (Miller, 1994)