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

The numbers of pregnancies complicated by early-onset type 2 diabetes continue to increase. During 2022, there were 2,975 pregnancies in women with early-onset type 2 diabetes, the highest number ever recorded in the annual NPID audit. The complexity of looking after these women, who are older, and have higher BMI with associated co-morbidities, and are more often from ethnic minorities and living in deprived communities is such that intensive glycaemic management is often not prioritised before and during pregnancy.

Outside of pregnancy, most women with type 2 diabetes are seen in primary care, with data showing that 64% were prescribed glucose lowering agents. However, only a minority were treated with insulin (14.5%) or offered CGM technology (14%) to reach their pregnancy glucose targets. Only 36% achieved the NICE recommended target HbA1c of <48mmol/mol², with no improvement in early pregnancy HbA1c over the past 9 years. Likewise, the proportion achieving the pregnancy glucose target of HbA1c <43mmol/mol after 24 weeks gestation has also not improved over the past 9 years (55.3%, 54.0%, 54.5%, during 2021 and 2022, 2019 and 2020, and previous years). Rates of preterm births, large birthweight babies and neonatal care unit admissions are all also unchanged for these women.

It is concerning that rates of perinatal deaths are increasing for women with early-onset type 2 diabetes, especially when previous data³ confirmed that these baby deaths are potentially preventable by improving maternal glucose during pregnancy. The 2019 and 2020 NPID audit further confirmed that rates of perinatal deaths, preterm births, large birthweight babies and neonatal care unit admissions were all lower in mothers who achieved the pregnancy glucose target of HbA1c <43mmol/mol after 24 weeks gestation.

The proportion of women with diabetes who are well prepared for pregnancy remains low among women with both type of diabetes. Well prepared for pregnancy is defined as achieving the recommended HbA1c target of <48mmol/mol in early pregnancy, taking 5mg folic acid before pregnancy, avoiding potentially harmful medications and presenting for antenatal care before 10 weeks gestation in line with NICE guidelines. As in other measures of pregnancy diabetes care, there are encouraging signs of improvement for women with type 1 diabetes during 2021 and 2022 (17.7%, 13.4%, and 12.7%), but not for women with early-onset type 2 diabetes (9.5%, 11.3% and 12.0%) over the 3 NPID time periods 2021 and 2022, 2019 and 2020 and 2014 to 2018. The socio-economic gradient is noticeable for women with both types of diabetes, with approximately twice as many well prepared pregnancies among women living in the 2 least deprived quintiles vs the 2 most deprived quintiles (41.4% vs 16.9% type 1, 34.7% vs 18.6% type 2). Ethnic disparities are also apparent, particularly impacting preparation for pregnancy among Black women.