• Project led by Derby Hospitals NHS Foundation Trust.
  • Focused on pre-pregnancy care in primary and secondary care settings.
  • Aimed to raise awareness of the need for pre-pregnancy care for women with diabetes, among women themselves along with professionals such as pharmacists, health visitors and fertility clinicians.
  • Developed an innovative model of community-based pre-pregnancy care for women with diabetes, tailored to individual needs.

The Derby Hospitals NHS Foundation Trust team wanted to educate women with diabetes about the importance of pre-pregnancy care and to raise awareness of the issue with health professionals. Their aims were to:

  • improve access to pre-pregnancy care, particularly for hard to reach groups
  • deliver a better pre-pregnancy care experience
  • increase the number of women receiving pre-pregnancy care
  • improve pregnancy outcomes.

The intervention involved:

  • sending written information to women with diabetes aged 18-45
  • an initial consultation in a hospital or community-based clinic, focusing on reducing the risks associated with diabetes and pregnancy
  • a personalised care plan involving primary and secondary care services
  • focusing consultants' time on seeing only those at highest risk
  • providing continuity of care, with women seen by the same team members in the antenatal service once pregnant.

Who was involved

The project was delivered by a multidisciplinary team and spanned the boundaries of primary and secondary care and clinical specialities.

Impact

The intervention improved the effectiveness, efficiency and timeliness of pre-pregnancy care for women with diabetes:

  • activity doubled and median waiting time reduced from 13 to 5 weeks despite a 50% increase in capacity
  • proportion of missed appointments reduced from 18% to 5%
  • after 12 months, pre-pregnancy care rate rose from 48% to 70% and stillbirth rate reduced from 6% to 0%
  • greater engagement with women from traditionally hard to reach groups, particularly young adults and South Asian women from low socio-economic groups
  • cost savings of £61,000.

Challenges

Having a database and input from a finance manager was invaluable for evaluating impact and cost savings. However the involvement of a health economist would have further added to the evaluation.

Further reading