“I'm a clinician and I'm doing diabetes on the ward, and I suddenly see some things which I have not seen very often in the 25 years I’ve looked after women with diabetes in pregnancy.”
When David Simmons first came to Sydney he noticed an unusually high percentage of birth defects in newborn babies born to women with diabetes. Rates reported in South Western Sydney were approximately 12% in comparison to rates of 2% reported in other populations. Possible reasons for this higher rate included unplanned pregnancies, a lack of awareness of the need for good blood glucose control in pregnancy and delayed input from antenatal services.
Simmons, who is the Program Lead of the Diabetes Obesity and Metabolic Disease Clinical Academic Group at Maridulu Budyari Gumal, says the impact of these stats is far reaching.
Babies born with defects have a severe impact on the emotional and mental health of mothers. They also are a major cost to the country: each major malformation has an estimated lifetime cost of $1 million. This is a heavy price to pay for a health issue that can be avoided with the right pre-pregnancy care.
Impact on mothers
There are all sorts of complications associated with babies born to Mothers with diabetes. Traumatic labour, stillbirths, babies born with holes in their heart or open spines. The lifetime effects of these malformations are not to be ignored.
As Simmons points out, “no mother wants to damage their baby” and most mothers are unaware of the risks associated with diabetic pregnancies. Especially as these are traumatic experiences that could have been avoided.
“We clearly have an area in which there's a major issue in the readiness of women with diabetes to become pregnant. Many of those were unplanned pregnancies, so they weren't using contraception, and when I spoke with women, they weren't aware of the risk.”
Knowing this, Simmons made it his mission to do something.
The Diabetes Contraception and Pre-pregnancy Program
Supported by Maridulu Budyari Gumal, David and his team developed an innovative outreach program. Called the Diabetes Contraception and Pre-pregnancy Program (DCAPP), the aim of the program is to reduce the risk of Mothers with diabetes giving birth to babies with defects.
How the program works
The aim of the program is to increase awareness of the risks, particularly for unplanned pregnancies. The program also promotes contraception, ensures pre-pregnancy care is readily available, and advocates for the creation of pre-pregnancy clinics.
Through it, the DCAPP team works with GPs, pharmacists, fertility clinics, private endocrinologists and hospitals to:
- keep professionals up-to-date with the latest developments in this space;
- hand out literature that professionals can pass on to diabetic women;
- encourage women with diabetes to take the right supplements and join pre-pregnancy clinics;
- offer free, online education to professionals working in diabetes; and
- create apps, literature, information packs and tools to help patients.
Since the launch of the program, the team has visited 390 general practices, 189 pharmacies and 30 private clinics. Simmons believes there is no excuse for health professionals to not know about the risks.
Getting pre-pregnancy care right
There are only a few pre-pregnancy clinics in NSW or even across Australia. Yet these are vital to this type of work.
Pre-pregnancy clinics can achieve what routine clinics fail to: prepare women so that they’re aware of the risks, avoid and reduce perinatal death, and reduce malformations.
Creating more pre-pregnancy clinics around the country is a central focus for the DCAPP program.
Making integrated diabetic care a priority
Diabetes in Australia has reached epidemic proportions. It costs the taxpayer 10 to 15% of the money that goes into health. Without integrated diabetes care and prevention, this epidemic will only get worse.
Combining pre-pregnancy care with integrated care should be mandatory for women of reproductive age with diabetes. Each health professional in a woman’s care journey needs to communicate and connect the dots. This will ensure high-risk patients are quickly identified and cared for.
Taking the program to other communities
To date, the program has been tested in one area where antenatal and endocrinologist services are co-located. The team intends to take what they’ve learned and start similar programs, armed with more knowledge to other areas.
If appropriate, Simmons says, “we’d want to take it to rural and regional areas, and Aboriginal services as well.”
He continues, “If you see something wrong, and it's within your power to try to change it, then I think you should.”