National Pregnancy in Diabetes Audit 2021 and 2022 (01 January 2021 to 31 December 2022)

This is an overview for 2021 and 2022 of the demographics, treatment and outcomes in 10,225 pregnancies in women from England and Wales with diabetes.

Pregnancy outcomes improved in those with type 1 diabetes. In women with type 1 diabetes there were fewer serious adverse pregnancy outcomes (congenital anomalies, stillbirths and neonatal deaths) compared to the previous seven years (5.9% 2014 to 2020 vs 5.1% in 2022).

Increasing use of glucose monitoring technology before and during pregnancy has been the major change. Most important, is the reduction in serious adverse pregnancy outcomes (4.4% on CGM vs 6.2% not on CGM in 2021 and 2022), including a reduction in perinatal deaths. The use of glucose monitoring systems was also associated with fewer preterm births (39.5% on CGM vs 43.9% not on CGM in 2021 and 2022), fewer large birthweight babies (45.6% on CGM vs 53.5% not on CGM in 2021 and 2022) and fewer neonatal care unit admissions (44.8% not CGM vs 48.5% not on CGM in 2021 and 2022).

Women with early-onset type 2 diabetes now outnumber those with type 1 diabetes (4,290 for type 1 vs 5,415 for type 2 in 2021 and 2022). However, in stark contrast to women with type 1 diabetes there were no improvements in women with early-onset type 2 diabetes. There was no change in their achievement of the recommended glucose treatment targets (55%), they had more pregnancy losses (315 miscarriages for type 1 vs 560 for type 2 in 2021 and 2022) and more serious adverse pregnancy outcomes (5.1% for type 1 vs 6.6% for type 2 in 2022), including more stillbirths (45 for type 1 vs 55 for type 2 in 2021 and 2022) and neonatal deaths (35 for type 1 vs 70 for type 2 in 2021 and 2022).

There are 3 recommendations for commissioners of care.