Diabetes in pregnancy - education for healthcare professionals

In the past diabetes during pregnancy posed a great risk to women’s health and the health of their babies but now more is being done to support women to manage their diabetes and reduce those risks.

Managing diabetes in pregnancies should not solely be the responsibility of the patient as it requires more than self-management, it calls for the support of a whole community of healthcare professionals. Anna Brackenridge [pictured] is a consultant at Guy's and St Thomas’ NHS Foundation Trust who leads a diabetes in pregnancy clinic.

Jessica Shankland, Communications Officer at KHP, met with Anna to find out how her part of a new masterclass could help the wider healthcare team improve the delivery of care for pregnant women with diabetes.

What does the diabetes in pregnancy clinic do?  

It's an exciting service to be involved in. At the clinic we get to help women with pre-existing type 1 and type 2 diabetes as well as people with gestational diabetes - a type of diabetes that develops during pregnancy when the body cannot produce enough insulin to meet the additional needs brought on by pregnancy.

Our multi-disciplinary team supports patients through joint clinics and specific gestational diabetes clinics. Together we support patients to reduce the health risks brought on by diabetes during pregnancy by helping them to effectively manage their diabetes.

Why do pregnant women with diabetes need our help?

Pregnant women can reduce the risks to their personal health and the health of their babies by keeping their diabetes well controlled, but because it's a time of such huge change, diabetes self-management is not easy to do. So many factors make it difficult for women to keep their glucose levels well controlled.

In the second half of pregnancy people can become more insulin resistant because of hormones the placenta makes (this is when people without diabetes can develop gestational diabetes). People who had diabetes before pregnancy and were already on insulin can see their doses double or even triple by the end of pregnancy.

Then after having the baby, glucose levels drop so women go from needing large amounts of insulin to suddenly needing a lot less. As well as these hormonal changes happening throughout pregnancy, the glucose level targets that we use during pregnancy change. This is a lot to understand and adapt to in a short space of time and challenging to manage without lots of support. 

Pregnancy can be a time of great joy but also great stress, particularly for people with diabetes, so at the clinic we try to help patients navigate all those challenges. Being a part of that journey and helping people do that successfully, that's what we’re all interested in trying to do. We are also here to support by monitoring carefully for the complications of pregnancy, like preeclampsia, that are more common for people with diabetes. 

We watch out for those complications to try and manage them safely. Then there's the mental health factor of diabetes in pregnancy. I have known patients experience guilt because of the pressures of managing their diabetes - they worry they haven't done things as they well as they think they should have - so we like to be there to remind them that they're doing the best they can. 

How can a mind and body approach help patients?  

There is a big emphasis on mental health in pregnancy because pregnancy can bring up previous mental health issues or bring new ones to the fore. We think about mental health a lot. In our clinic we see patients who try to do so much on top of trying to manage their diabetes.

We think we should be doing really clever things to help but sometimes the best intervention is talking to a patient about what they are struggling with. The solution doesn’t have to be a medication, it can be support with social factors that are impacting their ability to do what they need to do to manage their diabetes. As clinicians we need to learn to recognise when people are struggling or when they don't want to be seen as not coping. Think if it were your friend, what would you say?

What are the challenges for clinicians working in this field? 

For people with type one diabetes, most will know clinicians from the diabetes clinic but once they have their baby they may be looked after by teams who aren't as familiar with their condition.

For type 2 diabetes we need to raise awareness around the importance of coming into clinic quickly once pregnant so we can deliver the right treatment early. For people with gestational diabetes, it's an enormous amount of learning in a short space of time so that is another challenge that we encounter.

Another challenge that we are working to address is that people from deprived groups are known to have worse outcomes, so we need to make our services accessible and equitable, so people receive the care that's right for them.

How can healthcare professionals support this patient group?   

Pregnant women with diabetes cross a wide range of healthcare providers so it's important everyone has some awareness about diabetes in pregnancy. We have developed a Diabetes in Pregnancy Bite-sized Teaching session. The Diabetes in Pregnancy session helps students and professionals to develop their knowledge and communication skills so they can deliver better care for pregnant women with diabetes. 

We designed the bite-sized teaching session to benefit a wide audience. The session supports students by providing a step towards being part of the medical setting while studying. It benefits all professionals who are curious about diabetes in pregnancy. It will provide up to date knowledge for GPs, midwives, sonographers, nurses and doctors to become more confident in their practice, because wherever you work in healthcare, there is a lot to be gained by learning about Women's Health.

This session won’t teach everything about diabetes, but it will help professionals learn how to deal with diabetic emergencies that they might encounter on the ward, as well as principles of providing high quality care for pregnant women with diabetes.

The session will be delivered online in November, for registration enquiries please contact Education and Training team at khp-iwch@kcl.ac.uk.