Number of women with gestational diabetes underestimated

A new study claims that twice as many women as previously thought develop gestational diabetes during pregnancy.

The research shows that 16 per cent of women develop gestational diabetes during pregnancy compared to previous estimates that only 8 per cent develop the condition.

The findings of this international research involving 23,000 women in nine countries will be published in the March issue of Diabetes Care, a journal of the American Diabetes Association.

Welcomed results

Cathy Moulton, Care Advisor at Diabetes UK, said: “Diabetes UK welcomes the long-awaited results of this multi-national study. The research shows that the blood glucose levels of pregnant women, which were once deemed to be in the normal range, are now seen to be those of a person with gestational diabetes. This means that two to three times more pregnant women could be diagnosed with gestational diabetes than at the present moment.

“These blood glucose levels, if left undetected, have the potential to produce large babies and lead to an increased risk of injury during delivery, which causes many women to have a caesarean section.”

“Diabetes UK, who funded the Manchester and Belfast arm of this study, awaits the publication of the full study next month and the consequences it could have in the detection and treatment of gestational diabetes.”

About gestational diabetes

Gestational diabetes arises during pregnancy – usually during the second or third trimester. In some women, it occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy. In others it may be found during the first trimester of pregnancy, and in these women the condition most likely existed before the pregnancy.

In the majority of cases, gestational diabetes comes to light during the second trimester of pregnancy. The baby’s major organs are fairly well developed at this stage and the risk to the baby is lower than for women with Type 1 or Type 2 diabetes.

However, babies of women who had blood glucose problems that were undiagnosed before pregnancy have a higher risk of malformations. The degree of risk depends on how long blood glucose levels have been high and on how high the levels have been.

Visit the pregnancy and diabetes secion of our website for more information.

Pregnancy and alcohol – a dangerous cocktail

Learning difficulties, physical disabilities and behavioural problems are all part of fetal alcohol spectrum disorders [FASD].  These lifelong conditions can drastically impact on the lives of the individual and those around them. BMA Scotland said today (Monday 1 March 2010) that the reality is that these conditions are completely preventable by not drinking any alcohol during pregnancy.

There is proven risk that heavy drinking by pregnant women can cause these disorders in their children. However, evidence is continuing to emerge on the effects of low or moderate prenatal alcohol exposure and until there is clarification the only message is that it is not safe to drink any alcohol during pregnancy or when planning a pregnancy.

Dr Brian Keighley, Chairman of the British Medical Association in Scotland said: “We need to raise awareness of the emerging evidence on FASD among healthcare professionals so that children are diagnosed quickly and get the help they need. The lack of awareness and research in the UK on this subject, together with the complexity of the syndrome itself is leading to delays in diagnosis and referral.

“Healthcare professionals also need to get the message across to expectant mothers that consuming alcohol can cause irreversible harm to their unborn child. It’s about giving people the right information so that they can act responsibly – and save children from completely preventable life-long disabilities.”

The BMA published a report on FASD in June 2007.  Recommendations in the report include:

There is an urgent need for further UK and international research on FASD.

Research should be undertaken to examine the relationship between different levels of prenatal exposure and the range of conditions associated with FASD.

The UK health departments should implement guidance and training programmes for healthcare professionals on the prevention, diagnosis and management of FASD.

Women who are pregnant, or who are considering a pregnancy, should be advised not to consume any alcohol.

Research should be undertaken to identify the most effective ways to educate the public about FASD and to alter drinking behaviour. This requires systematic studies that compare various universal strategies and their impacts across the different social groups.

All healthcare professionals should provide clear and coherent advice for expectant mothers and anyone planning a pregnancy on the risks of maternal alcohol consumption. Members of the antenatal care team should provide continued advice and support to expectant mothers throughout pregnancy.

Any woman who is identified as being at high-risk of prenatal alcohol exposure should be offered referral to specialist alcohol services for appropriate treatment. Any referral should be followed up and assessed at regular intervals.

Notes:

Each time the acronym FASD is used it refers to the full range of disorders that fall within the umbrella term FASD, unless otherwise stated. These disorders range in diversity from the most clinically recognisable type; Fetal Alcohol Syndrome (FAS), to a set of conditions – including Partial Fetal Alcohol Syndrome (PFAS), Alcohol-Related Birth Defects (ARBD) and Alcohol-Related Neurodevelopment Disorders (ARND) – that show some, but not all of the features of FAS. The severity of the abnormality depends on the level and pattern of alcohol consumed as well as the stage of pregnancy at which alcohol was consumed.

The BMA report ‘Fetal alcohol spectrum disorders’, a guide for healthcare professionals’; can be accessed on our website at: http://www.bma.org.uk/health_promotion_ethics/alcohol/Fetalalcohol.jsp

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BLISS CHARITY AND NEONATAL CARE IN ENGLAND

House of Commons Early Day Motions

Bob Spink [R]
Peter Bottomley
Bob Russell
Andrew George
Mr Gregory Campbell
Mr David Drew
	Dr Rudi Vis	Dr William McCrea	Ms Katy Clark

That this House notes that 70,000 babies were admitted to neonatal care in England in 2008, almost 20,000 of those being admitted to intensive care; further notes that Bliss is the only UK charity that helps care for premature and sick babies; congratulates Bliss on 30 years of campaigning that has resulted in an NHS neonatal taskforce conducting the most comprehensive review of neonatal care ever undertaken in England; and calls on the Government to implement fully the Taskforce’s recommendations in order to make a lasting improvement in the way babies and their families are cared for.

Departmental Public Expenditure – Health

Mrs. Maria Miller:

To ask the Secretary of State for Health how much his Department has allocated to Maternity Matters programmes in (a) 2009-10 and (b) 2010-11.

Ann Keen:

In January 2008, the Department announced an additional £330 million for maternity services to help support the implementation of Maternity Matters over the three years 2008-09 to 2010-11. This funding has been included in primary care trusts (PCT) baseline allocations. It is for PCTs to determine how best to use based on the needs of local maternity services.

Mrs. Maria Miller:

To ask the Secretary of State for Health how much his Department has allocated for NHS Baby Lifecheck in (a) 2009-10 and (b) 2010-11.

Gillian Merron:

Expenditure on NHS Baby Lifecheck in 2009-10 is expected to be approximately £1.3 million. The allocation for NHS Lifecheck in 2010-11 is still under consideration.

Improvements to care for sick and premature babies in Wales

 Health Minister Edwina Hart today [Monday, 7 December] accepted the recommendations of an expert group on improvements to care for sick and premature babies in Wales.

The group, led by Dr Jean Matthes, Consultant Neonatologist at Abertawe Bro Morgannwg University Health Board, has produced a plan to improve neonatal services. Priorities include introducing dedicated neonatal transport services, improved information systems, and the establishment of a Neonatal Managed Clinical Network for Wales. The network should be operational in February.

The group’s recommendations outline how the additional £2million a year of Assembly Government funding announced by the Minister for neonatal services will be spent.  Planned improvements include:

Two neonatal transport services, one in south Wales and one in north Wales. The transport services will ensure rapid and safe transport to specialist centres. The services will operate 12 hours a day in the first instance, with planned progress towards a 24-hour service in the future as staff resources are developed. The new service should be operational from spring next year.

Specialist Neonatal services concentrated in three centres in South Wales – Swansea, Cardiff and Newport – and one in North Wales, yet to be determined.

Recruitment to begin for additional Neonatal Consultants and Neonatal Nurses at each centre to deliver the new service.

A single Neonatal Database enabling the standardised collection of data across Wales.

Dr Jean Matthes, Chair of the Expert Group, said: “I am absolutely delighted with the development of the neonatal transport services, database and network.  This will significantly help to improve the services for newborn babies and their families throughout the whole of Wales.”

Dr Huw Jenkins, Consultant Paediatrician at University Hospital of Wales, Cardiff, added: “This is a very welcome announcement and I am pleased that the hard work of the clinicians and others involved in developing the neonatal standards and service models is coming to fruition.”

Home birth figures remain static across UK

Across the UK in 2008, 21, 211 (2.7%) of all births (787,032) took place at home, compared with 20,548 (2.68%) in 2007. This shows no rise in the home birth rate.

In England 18,933 women (2.8%) had a home birth, from 665,779 births.

Wales has the highest proportion of women having home births, 1,314 (3.7%) from 35,256 births.

In Scotland, 881 women (1.5%) had a home birth, from 60,366 births. And in Northern Ireland, 83 women (0.3%) had home births from 25,631 births.

In many areas community midwifery services are not being developed to increase access to home births and birth centres, and women are not being given balanced information to make well-informed choices. Low midwifery staffing levels mean home birth is either not being offered, or withdrawn at short notice. Every trust and board should ensure that choice of place of birth is available to all women.

Local administrative areas with highest and lowest home birth rates include:-

		HIGHEST		LOWEST
England		South Hamms – 13.6%		Alnwick 0.0%
Scotland		East Lothian – 5.0%		Eilean Siar – 0.4%
Wales		Bridgend – 9.5%		Merthyr Tydfil – 1.3%

New data provided by the Office of National Statistics, The General Register Office for Scotland and the Northern Ireland Statistics and Research Agency. Statistics analysed by BirthChoiceUK – available at www.BirthChoiceUK.com/HomeBirthRates.htm

Doulas – a help for mums

Commenting on BMJ.com, a doctor today says that the presence of doulas during labour may alter the doctor-patient dynamic and can compromise communication and therefore patient care.

Furthermore, the need for doulas implies a failing of medical and midwifery services and also the support provided by family and friends, says Dr Abhijoy Chakladar who was working at Worthing Hospital in West Sussex when he first encountered a doula.

Background

There are two types of doula – birth and postnatal – and some cover both areas. A birth doula is there to offer physical and emotional support to you (and your partner) during labour and for your birth. They don’t do anything medical but are a continuous, reassuring presence.

Most (but not all) doulas are mothers themselves and may or may not have done additional training. Those recognised by Doula UK will have completed an approved training course and will have de-briefed and reflected on what birth means for them. A birth doula will usually cost between £200 and £600. Postnatal doulas are there to support you at home after the birth – ‘mothering the mother’ so you can mother your baby.

Improvements to care for sick and premature babies in Wales

Health Minister Edwina Hart today [Monday, 7 December] accepted the recommendations of an expert group on improvements to care for sick and premature babies in Wales.

The group, led by Dr Jean Matthes, Consultant Neonatologist at Abertawe Bro Morgannwg University Health Board, has produced a plan to improve neonatal services. Priorities include introducing dedicated neonatal transport services, improved information systems, and the establishment of a Neonatal Managed Clinical Network for Wales. The network should be operational in February.

The group’s recommendations outline how the additional £2million a year of Assembly Government funding announced by the Minister for neonatal services will be spent.  Planned improvements include:

Two neonatal transport services, one in south Wales and one in north Wales. The transport services will ensure rapid and safe transport to specialist centres. The services will operate 12 hours a day in the first instance, with planned progress towards a 24-hour service in the future as staff resources are developed. The new service should be operational from spring next year.

Specialist Neonatal services concentrated in three centres in South Wales – Swansea, Cardiff and Newport – and one in North Wales, yet to be determined.

Recruitment to begin for additional Neonatal Consultants and Neonatal Nurses at each centre to deliver the new service.

A single Neonatal Database enabling the standardised collection of data across Wales.

Mrs Hart said: “I want to thank Dr Matthes and her team for the report on how we can deliver improvements to care for the most vulnerable babies.

“The implementation of their recommendations will improve clinical safety, and ensure that neonatal intensive care services are sustainable. More babies will be treated closer to their homes, with appropriate and safe transfer to specialist services where required.

“These proposals will facilitate progress towards the delivery of the All Wales Neonatal Standards that I launched in December last year. My aim is to deliver safe, sustainable services for the benefit of babies requiring specialist care and their families. .”

Dr Jean Matthes, Chair of the Expert Group, said: “I am absolutely delighted with the development of the neonatal transport services, database and network.  This will significantly help to improve the services for newborn babies and their families throughout the whole of Wales.”

Dr Huw Jenkins, Consultant Paediatrician at University Hospital of Wales, Cardiff, added: “This is a very welcome announcement and I am pleased that the hard work of the clinicians and others involved in developing the neonatal standards and service models is coming to fruition.”

Home birth figures remain static across UK

Across the UK in 2008, 21, 211 (2.7%) of all births (787,032) took place at home, compared with 20,548 (2.68%) in 2007. This shows no rise in the home birth rate.

In England 18,933 women (2.8%) had a home birth, from 665,779 births.

Wales has the highest proportion of women having home births, 1,314 (3.7%) from 35,256 births.

In Scotland, 881 women (1.5%) had a home birth, from 60,366 births. And in Northern Ireland, 83 women (0.3%) had home births from 25,631 births.

Local administrative areas with highest and lowest home birth rates include:-

		HIGHEST		LOWEST
England		South Hamms – 13.6%		Alnwick 0.0%
Scotland		East Lothian – 5.0%		Eilean Siar – 0.4%
Wales		Bridgend – 9.5%		Merthyr Tydfil – 1.3%

New data provided by the Office of National Statistics, The General Register Office for Scotland and the Northern Ireland Statistics and Research Agency. Statistics analysed by BirthChoiceUK – available at www.BirthChoiceUK.com/HomeBirthRates.htm

NCT members have contacted us to share their experiences of home birth. Please see below for some case studies.

Case Studies:

Rosie Evans, Rugby: “After giving birth to a stillborn girl, followed by a miscarriage, we were very anxious for the birthing experience to be special. We chose to have a home birth because I knew that in a hospital environment I would not feel able to birth, because for birth you need relaxation and for relaxation I need privacy and control.

The home birth was very positive. Everyone who meets our daughter comments how calm and contented she is. I have no doubt that this, my effective contractions and short labour were all down to the fact that she was born in water and at home.”

Helen O’Donnel, Worcester: Helen gave birth in a water bath at home with her mother, husband and two community midwives present. It was a very positive experience.

Charlene Lucas, Twickenham: “I chose to have a home birth and informed my midwife (at the GP surgery) at 20 weeks. She was supportive, but said she could not guarantee me a home birth. Someone would bring round my home birth kit at 37 weeks, bit I would only find out whether someone could attend my birth at home when I went into labour, otherwise I would need to go into hospital.

As it turned out, I was recommended to go into hospital as the baby was breech and the birth went well. However, it was not my first choice and had I been able to proceed with the home birth I would not have known where I would labour until the day it happened and had no idea who will be attending which is far from ideal!”

Suzanne Borrell, Brighton and Hove: “I attempted a home birth in August 2005 but ended up in an emergency c section situation. Midwives were very positive but on the day the midwife who was attending me left at 11pm after a brief visit ‘saying – I’m off home to get some sleep and I suggest you do the same’. Although it was early on in my labour I was in a lot of pain as my baby was posterior. I really could have used her support as well gas and air as the pain became almost unbearable as the hours passed.

I had a birthing pool but was nervous about using it without a midwife present. Next morning a lovely midwife then came with gas and air but I was by then exhausted by the pain. I was taken by ambulance at 5pm to Royal Sussex as labour was not progressing and had a c section at 11pm.

After having a very positive second birth in a birthing pool, I now know that the outcome would have been different if I had received more care earlier on as much of the pain came through stress and fear.”

Full list of statistics can be viewed at http://www.BirthChoiceUK.com/HomeBirthRates.htm

New guide to improve neonatal care

 

The Department of Health is today publishing new guidance to help the NHS improve the care provided for premature and sick babies during their first days.

 

The NHS has made great progress in caring for babies with the lowest infant mortality rates and NHS neonatal services now care for over 60,000 babies a year.

Babies who are born prematurely, or have a low birth weight, require very specialised care in their first hours and days.  A Neonatal Taskforce was established to identify ways of further improving services to offer the best neonatal care possible.  Experts from baby charity Bliss and specialist NHS staff have helped to develop the Neonatal Toolkit to share its findings and guidance with the NHS.

While England remains one of the safest places in the world to give birth, the Taskforce has recommended that neonatal care become more family-centred to ensure the psychological as well as physical needs of babies and families are considered.  The Toolkit they have created provides practical advice on how to improve the areas that really matter to parents including:

*       making sure the right staff are on hand at the birth

*      managing high-risk pregnancies to make sure babies are born in the best place

*       improving transfers between services where necessary

 Health Minister Ann Keen said:

“As a nurse I’ve seen the excellent care the NHS provides for small and premature babies, and the doctors and nurses working in neonatal care should be proud that more babies than ever before are surviving.

“Having a sick baby is very distressing for parents at what should be one of their happiest moments.  That’s why we’re providing the NHS with practical guidance on how to make neonatal services even better and take a family-centred approach to care.  To ensure this Toolkit makes a real difference to neonatal care I have also asked to have ministerial oversight of its implementation.”

Neonatal services have been boosted in recent years with the establishment of neonatal networks.  The networks ensure joined-up care in each area and have helped to increase the number of neonatal beds and staff across England.  The Neonatal Taskforce was established last year to identify and deliver further improvements to services.  The Taskforce will continue to support the NHS to introduce the recommendations made in the Toolkit and ensure it has a significant impact on neonatal care.