Pre-Pregnancy Counselling Clinic (includes Type 1 and Type 2 Diabetes)

About the Service

The service is focused on:

• Risk stratification and mitigation
• Detailed counselling on the impact of medical disease on pregnancy and vice versa
• Medication review and teratogenic risk management
• Supporting informed patient choice and timing of pregnancy
• Psychological support and expectation management
• Improving outcomes and reducing complications

When women with type 2 diabetes are planning a pregnancy this service provides them and their families with information about how diabetes affects pregnancy and how pregnancy affects diabetes which include:

• Assessments for existing complications and management
• Initial advice for managing diabetes including one stop medications review

Objectives

RCOG, NICE and NHS England all highlight that structured, multidisciplinary pre-pregnancy counselling for women with medical, surgical, and previous obstetric risk factors is essential to:

• Reduce maternal morbidity and mortality
• Reduce perinatal complications
• Improve patient choice, autonomy and safety

NICE guidance (including CG62 and subsequent maternal medicine frameworks) specifically supports specialist pre-conception input for women with chronic medical conditions, including diabetes

Pre-Pregnancy Clinic Details

• Ante Natal Clinic UHCW
• Every 3 weeks,Tuesday afternoon, 3 slots, 1 hour per patient
• Lead clinicians: Dr Vandana Dhingra with support from Dr Simon Fletcher and Dr Narasimha Murthy
• Aim of clinic: Pre-pregnancy counselling service for maternal medicine and obstetric risk factors to reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death (This includes patients with Type 2 Diabetes)

Referral criteria

• T2DM patients planning pregnancy on oral medications or insulin with or without other complications Women with renal disease, hypertension / cardiac conditions, rheumatology and autoimmune disease, neurology (including epilepsy), endocrine disorders, obesity, poor previous obstetric outcomes

Referral Sources:

• GP
• Advice & Guidance
• Consultant CRM: Reproductive Medicine
• Secondary Care Consultant
• Referrals to be triaged by a consultant prior to booking