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

Angiotensin-converting enzyme inhibitor; a class of drugs that reduce blood pressure by relaxing blood vessels.

Angiotensin receptor blockers are a class of drugs that reduce blood pressure by widening blood vessels.

Babies born at the expected weight for their gestational age. If a baby’s Gestation Related Optimal Weight (GROW) birth weight centile is between the 10th and the 90th centile, the baby is classed as AGA.

Any regimen involving a combination of background insulin either once or twice daily in combination with a short-acting insulin at mealtimes.

A measure of how a birth weight compares to the expected range of birth weights taking into account gestation, mother’s height, weight and ethnicity, and the sex of the baby. For example, a birth weight at the 90th centile means that for every 100 babies born to a woman with similar characteristics at that gestation, 90% would be expected to be lighter than this birth weight, and 10% would be expected to be heavier. GROW birth weight centiles are used in the National Pregnancy in Diabetes (NPID) Audit.

The body’s weight in kilograms divided by the square of the height in metres, used in assessing whether a person is overweight or underweight.

Antenatal appointment usually at between 8 to 12 weeks gestation at which a number of medical tests are completed and options for care during pregnancy and birth are discussed.

This is the hospital responsible for the booking appointment and is generally where the booking appointment is held.

Surgical abdominal delivery of a baby.

A way of measuring healthcare practice against national guidelines with the aim of improving the care provided by making recommendations for improvements.

A survey of pregnant women with diabetes in the UK (2002-03, published 2005).

A continuous glucose monitor (CGM) is a small device that is worn just under the skin. It measures glucose (sugar) levels through the day and night.

A range of values that assesses the level of uncertainty in an estimate that is caused by only obtaining values for a sample from the population. The 95% confidence interval gives the range in which you would expect the true value to fall 95 times if 100 samples were selected.

A physical or biochemical malformation that develops during pregnancy and is present at birth.

Number of live births, stillbirths, and miscarriages after 20 completed weeks and terminations with a congenital anomaly per 1,000 live and stillbirths.

This is where the delivery took place; this may be different to the booking hospital.

Patient records are assigned to 1 of 5 deprivation groups (called quintiles) using the Index of Multiple Deprivation (IMD) based on their postcode.

Diabetic ketoacidosis is a serious problem that can happen in people with diabetes if their body starts to run out of insulin. When this happens, harmful substances called ketones build up in the body, which can be life-threatening if it's not found and treated quickly.

A planned caesarean section when a medical need for the operation becomes apparent during pregnancy or the mother requests the operation in advance.

An unplanned caesarean when concerns for maternal and/or fetal wellbeing mean that the baby needs to be delivered as soon as possible.

Experts by Experience are people who have recent personal experience (within the last 5 years) of having diabetes and a pregnancy. They have previously been known as patient representatives.

A water-soluble vitamin in the B-complex group that helps to prevent fetal neural tube defects when taken by the mother before becoming pregnant. A 5mg dose can be obtained on prescription, and a 400mcg dose can be obtained over the counter.

A flash glucose monitoring system which measures sugar (glucose) levels continuously throughout the day.

The time from conception to birth, assessed by an ultrasound scan or measured from the first day of the last normal menstrual period if calculated prior to the earliest ultrasound scan.

Control of blood glucose.

Gestation Related Optimal Weight.

Glycosylated haemoglobin, measured in mmol/mol, reflects how well the blood glucose level has been controlled over the previous 2 – 3 months.

An abnormally high level of blood glucose.

An abnormally low level of blood glucose.

The process of attempting to start labour artificially. Methods of induction used are drugs that act like natural hormones to start labour, physical methods such as breaking waters or a combination of both drug and physical methods.

Assisted vaginal delivery of the baby using ventouse or forceps

A regime where short acting insulin is administered subcutaneously and continuously long term using an infusion device.

Care provided for babies who are the most unwell or unstable and have the greatest needs in relation to staff skills and staff-to-patient ratios (Level 3) (British Association of Perinatal Medicine, 2011).

A measure of the spread of data items around the median value – the values taken by the middle 50% of the data items, when the data items are in order.

Babies born larger than they should be for their gestational age. If a baby’s GROW birth weight centile is above the 90th centile, the baby is classed as LGA.

The last menstrual period the woman had before pregnancy.

The number of days spent in hospital, from admission to discharge.

Please see ‘freestyle libre’ above.

A statistical model used to estimate the probability of an outcome based on the values of one or more explanatory variables.

High birth weight (4,000g or more), a recognised complication for babies of women with diabetes

Maturity onset diabetes of the young caused by a single gene defect and associated with decreased insulin production and varying degrees of clinical severity.

The average value, sum of all values divided by the number of values.

The middle value when the data is in ranked order.

An oral hypoglycaemic agent that decreases blood glucose levels.

Spontaneous ending of a pregnancy before 24 weeks of gestation.

Any regimen using biphasic insulins or background insulin exclusively (i.e. without additional meal time insulin).

Multiple dose injection (MDI) therapy, also known as multiple daily injections, is an alternative term for the basal/bolus regime of injecting insulin. The therapy involves injecting a long acting insulin once or twice daily as a background (basal) dose and having further injections of rapid acting insulin at each meal time. Multiple daily injection therapy will usually involve at least 4 injections a day.

A clinical audit of the effectiveness of diabetes healthcare against the National Institute for Health and Care Excellence (NICE) Clinical Guidelines and NICE Quality Standards in England and Wales, that collects data from GP practices and specialist diabetes services.

Care provided for babies who cannot stay with their mothers on the postnatal ward.

Death of a live born baby before 28 completed days after birth.

The number of neonatal deaths per 1,000 live births.

A major congenital anomaly caused by abnormal development of the neural tube, the structure present during early pregnancy which later gives rise to the central nervous system (brain and spinal cord).

The National Institute for Health and Care Excellence (NICE) is the independent regulatory body providing national guidance and advice to improve health and social care

Care provided for babies who themselves have no medical indication to be in an intensive care unit in hospital (None or Level 1) (British Association of Perinatal Medicine, 2001) and can therefore stay with their mother on the postnatal ward.

Medicines taken by mouth that are used to help lower blood sugar levels in people with diabetes, which may be used alone or in combination with insulin.

The number of previous pregnancies where the woman has delivered 1 or more live or stillbirths.

A stillbirth or neonatal death.

Counselling and clinical management for women with diabetes, including ensuring near-normal glycaemic control before conception, commencing high dose of folic acid, reviewing medication, screening for diabetes complications, and giving information about pregnancy risks, appropriate diet, and lifestyle.

Delivery before 37 completed weeks’ gestation (37+0 weeks).

A condition related to diabetes where there is damage to small blood vessels that supply the eye, affecting sight.

A pregnancy with a single fetus/baby.

Babies born smaller than they should be for their gestational age. If a baby’s GROW birth weight centile is below the 10th centile, the baby is classed as SGA.

Care provided for babies who require additional care delivered by the neonatal service but do not require either intensive or high dependency care (Level 2) (British Association of Perinatal Medicine, 2011).

A baby delivered vaginally without instrumental assistance.

A group of medicines that can help lower the level of cholesterol in the blood to help prevent heart disease.

Legal definition from Section 41 of the Births and Deaths Registration Act 1953 as amended by the Stillbirth Definition Act 1992: a child that has issued forth from its mother after the 24th week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life.

The number of stillbirths per 1,000 total births (live births and stillbirths).

One of the 3 month periods into which pregnancy is divided. The first trimester is 0-12 completed weeks of gestation. The second trimester is 13-28 completed weeks gestation, and the third trimester is 29 weeks of gestation until birth.

The person’s insulin producing cells are permanently destroyed so no insulin is produced. The person needs regular insulin, given either by injection or an insulin pump.

The person’s insulin producing cells produce too little, and/or the insulin produced is not effective (insulin resistance). The condition may be controlled by diet and exercise alone, or the person may also need diabetes medication or insulin.

Early pregnancy HBA1c <48 mmol/mol, taking 5mg folic acid and not taking any potentially harmful medications.