Quality statement 3: Measuring HbA1c levels at booking appointment

Quality statement

Pregnant women with pre‑existing diabetes have their HbA1c levels measured at their booking appointment.

Rationale

Measuring a woman's HbA1c levels can be used to determine the level of risk for her pregnancy. Women who had diabetes before they became pregnant should have their HbA1c levels measured during early pregnancy to identify the risk of potential adverse pregnancy outcomes and to ensure that any identified risks are managed.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that pregnant women with pre‑existing diabetes have their HbA1c levels measured at their booking appointment.

Data source: National Pregnancy in Diabetes Audit and local data collection.

Process

Proportion of pregnant women with pre‑existing diabetes who have their HbA1c levels measured at their booking appointment.

Numerator – the number in the denominator who have their HbA1c levels measured at their booking appointment.

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

Data source: National Pregnancy in Diabetes Audit and local data collection.

Outcome

a) Mode of birth.

Data source: National Pregnancy in Diabetes Audit and local data collection.

b) Adverse fetal outcomes.

Data source: National Pregnancy in Diabetes Audit and local data collection.

c) Maternal diabetic complications.

Data source: National Pregnancy in Diabetes Audit and local data collection.

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

Service providers (in secondary care) ensure that systems are in place so that pregnant women with pre‑existing diabetes have their HbA1c levels measured at their booking appointment.

Healthcare professionals (in antenatal care and in joint diabetes and antenatal care teams) ensure that they measure the HbA1c levels of pregnant women with pre‑existing diabetes at the booking appointment.

Commissioners (clinical commissioning groups) ensure that they commission services in which pregnant women with pre‑existing diabetes have their HbA1c levels measured at their booking appointment.

What the quality statement means for patients

Pregnant women who had diabetes before they became pregnant have their HbA1c levels measured at their booking appointment (their first official antenatal appointment).

Source guidance

Definitions of terms used in this quality statement

Booking appointment

A woman with diabetes will usually have a booking appointment with the joint diabetes and antenatal care team by 10 weeks of pregnancy. In some cases this appointment may take place earlier in the pregnancy.

[Diabetes in pregnancy (NICE guideline NG3) and expert opinion]

Equality and diversity considerations

Pregnant women with diabetes and complex social needs may be less likely to access or maintain contact with antenatal care services, and may present to a service later than 10 weeks. Services should give special consideration to these groups of women and ensure that they have their HbA1c levels measured at the earliest opportunity.