Quality statement 1: High‑dose folic acid

Quality statement

Women with diabetes planning a pregnancy are prescribed 5 mg/day folic acid from at least 3 months before conception.

Rationale

High‑dose folic acid supplements (5 mg/day) should be prescribed for women with diabetes who are planning a pregnancy from at least 3 months before conception until 12 weeks of gestation. This is because these women are at greater risk of having a baby with a neural tube defect. The benefits of high‑dose folic acid supplementation should be discussed with the woman during preconception counselling as part of her preparation for pregnancy.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that women with diabetes planning a pregnancy are prescribed 5 mg/day folic acid from at least 3 months before conception.

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

Process

a) Proportion of pregnant women with type 1 diabetes prescribed 5 mg/day folic acid from at least 3 months before conception.

Numerator – the number in the denominator prescribed 5 mg/day folic acid from at least 3 months before conception.

Denominator – the number of pregnant women with type 1 diabetes.

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

b) Proportion of pregnant women with type 2 diabetes prescribed 5 mg/day folic acid from at least 3 months before conception.

Numerator – the number in the denominator prescribed 5 mg/day folic acid from at least 3 months before conception.

Denominator – the number of pregnant women with type 2 diabetes.

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

Outcome

Neural tube defects.

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 primary and secondary care) ensure that they have systems and processes in place so that women with diabetes who are planning a pregnancy are prescribed 5 mg/day folic acid from at least 3 months before conception.

Healthcare professionals (GPs, community midwives and healthcare professionals in joint diabetes and antenatal care teams) ensure that they prescribe 5 mg/day folic acid for women with diabetes who are planning a pregnancy, from at least 3 months before conception. Healthcare professionals also ensure that they advise women with diabetes who are planning a pregnancy about the benefits of taking high‑dose folic acid as part of preconception counselling.

Commissioners (NHS England area teams and clinical commissioning groups) ensure that they commission pre‑pregnancy services in which 5 mg/day folic acid is prescribed for women with diabetes who are planning a pregnancy, from at least 3 months before conception.

What the quality statement means for patients

Women with diabetes who are planning a pregnancy are given a prescription for high‑dose folic acid (one 5 mg tablet a day) for at least 3 months before they get pregnant and for the first 12 weeks of pregnancy. This helps to lower the chances of the baby having a condition called a neural tube defect (for example, spina bifida).

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