Pre-pregnancy care in diabetes Derby Hospitals NHS Foundation Trust

The Derby Hospitals NHS Foundation Trust team wanted to educate women with diabetes about the importance of pre-pregnancy care and to raise awareness of the issue with health professionals. Their aims were to:

• improve access to pre-pregnancy care, particularly for hard to reach groups
• deliver a better pre-pregnancy care experience
• increase the number of women receiving pre-pregnancy care
• improve pregnancy outcomes.

The intervention involved:

• sending written information to women with diabetes aged 18-45
• an initial consultation in a hospital or community-based clinic, focusing on reducing the risks associated with diabetes and pregnancy
• a personalised care plan involving primary and secondary care services
• focusing consultants' time on seeing only those at highest risk
• providing continuity of care, with women seen by the same team members in the antenatal service once pregnant.

Who was involved

The project was delivered by a multidisciplinary team and spanned the boundaries of primary and secondary care and clinical specialities.

Impact

The intervention improved the effectiveness, efficiency and timeliness of pre-pregnancy care for women with diabetes:

• activity doubled and median waiting time reduced from 13 to 5 weeks despite a 50% increase in capacity
• proportion of missed appointments reduced from 18% to 5%
• after 12 months, pre-pregnancy care rate rose from 48% to 70% and stillbirth rate reduced from 6% to 0%
• greater engagement with women from traditionally hard to reach groups, particularly young adults and South Asian women from low socio-economic groups
• cost savings of £61,000.

Challenges

Having a database and input from a finance manager was invaluable for evaluating impact and cost savings. However the involvement of a health economist would have further added to the evaluation.