Quality statement 2: First contact with joint diabetes and antenatal care team

Quality statement

Women with pre‑existing diabetes are seen by members of the joint diabetes and antenatal care team within 1 week of their pregnancy being confirmed.

Rationale

Women with diabetes who become pregnant need extra care in addition to routine antenatal care. Members of the joint diabetes and antenatal care team are able to ensure that specialist care is delivered to minimise adverse pregnancy outcomes. Immediate access to the joint diabetes and antenatal care team within 1 week of her pregnancy being confirmed will help to ensure that a woman's diabetes is controlled during early pregnancy, when there in an increased risk of fetal loss and anomalies. It will also help to ensure that the woman's care is planned appropriately throughout her pregnancy.

Quality measures

Structure

a) Evidence of local arrangements to provide a joint diabetes and antenatal care team.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that women with pre‑existing diabetes are seen by members of the joint diabetes and antenatal care team within 1 week of their pregnancy being confirmed.

Data source: Local data collection.

Process

Proportion of women with pre‑existing diabetes who are seen by members of the joint diabetes and antenatal care team within 1 week of their pregnancy being confirmed.

Numerator – the number in the denominator who are seen by members of the joint diabetes and antenatal care team within 1 week of their pregnancy being confirmed.

Denominator – the number of pregnant women with pre‑existing diabetes.

Data source: National Pregnancy in Diabetes Audit.

Outcome

a) Maternal satisfaction.

Data source: Local data collection.

b) Perinatal morbidity.

Data source: Local data collection.

c) Perinatal mortality.

Data source: Local data collection.

d) Maternal adverse outcomes.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (in secondary care) ensure that referral pathways are in place so that pregnant women with pre‑existing diabetes are seen by members of the joint diabetes and antenatal care team within 1 week of the pregnancy being confirmed.

Healthcare professionals (in joint diabetes and antenatal care teams) ensure that they see pregnant women with pre‑existing diabetes within 1 week of the pregnancy being confirmed.

Commissioners (NHS England area teams and clinical commissioning groups) ensure that they commission joint diabetes and antenatal care teams that see pregnant women with pre‑existing diabetes within 1 week of the pregnancy being confirmed.

What the quality statement means for patients

Pregnant women who had diabetes before they became pregnant have an appointment with a joint diabetes and antenatal care team within 1 week of telling a doctor, nurse or midwife that they are pregnant.

Source guidance

Definitions of terms used in this quality statement

Joint diabetes and antenatal care team

A clinic with a multidisciplinary team consisting of an obstetrician, a diabetes physician, a diabetes specialist nurse, a midwife and a dietitian.

[National service framework for diabetes]

Pregnancy confirmed

The notification of a positive pregnancy test to a healthcare professional. This may be a GP, practice nurse, midwife or member of the secondary care diabetes team.

[Expert opinion]