Discuss importance of managing diabetes before pregnancy with patients
02 Jul 2024
Having support from a GP to plan and manage the pregnancies of women with diabetes can reduce complications for both the mother and baby.
South Western Sydney PHN (SWSPHN) is hosting a webinar during National Diabetes Week, 14 to 21 July, which emphasises the importance of having routine conversations with patients about managing their diabetes before becoming pregnant.
Head of the Campbelltown Hospital Endocrinology Department, Professor David Simmons, will present the Diabetes Contraception and Pre-pregnancy Program (DCAPP) webinar on Thursday, 18 July, from 7pm.
What is DCAPP?
DCAPP has been designed to develop a more integrated approach to supporting women of childbearing age with type 1 and type 2 diabetes.
SWSPHN is working in partnership with Western Sydney University and South Western Sydney Local Health District to implement the program in our region.
For women with pre-existing diabetes, understanding and managing the risks of unplanned pregnancies, undertaking pre-pregnancy planning and maintaining glycaemic level target ranges before and throughout pregnancy can significantly increase the likelihood of having a healthy baby.
Similar programs implemented elsewhere have reduced the rates of congenital malformations, miscarriage and stillbirths by up to 70 per cent.
DCAPP aims to open up early conversations between GPs and their patients about the seriousness and potential complications of becoming pregnant if the patients’ diabetes is not well-managed.
It provides GPs with guidance on managing these patients, including about referring patients with diabetes who are planning pregnancy to one of the diabetes pre-pregnancy clinics across our region. For patients who are not planning pregnancy, GPs are encouraged to discuss the importance of contraception with your patients with diabetes.
How are patients benefiting from DCAPP?
Mother of two, Rachel Hicks (pictured), was diagnosed with type 1 diabetes when she was five.
She said encouragement and support from her treating team at Macarthur Diabetes Service at Campbelltown Hospital, and Professor David Simmons introducing the Diabetes Contraception and Pre-pregnancy Program (DCAPP) at Campbelltown, made all the difference when she decided to start trying for a family.
Her team included a diabetes educator, an endocrinologist and a GP, who worked collaboratively to improve her blood glucose management and put plans in place to prepare for extra low blood sugar levels, and ensure she had access to the most appropriate devices like an insulin pump and a continuous glucose monitor.
“Going through my first pregnancy there was so much more information to take on about what I needed to do for myself, for my baby, for my family during that time. It was good to have a little bit of pressure relieved with access to a glucose monitor and getting more data on what was happening with my diabetes.”
How can diabetes care be more accessible?
Mrs Hicks is also undertaking PhD research examining lived experiences of diabetes and pregnancy, including working with DCAPP to look at peer support models.
She said her research had highlighted how there couldn’t be a one-size fits all approach to providing accessible care to, and engaging with vulnerable communities across South Western Sydney, including people from culturally linguistically and diverse (CALD) backgrounds.
“We’ve seen with diabetes programs delivered at Campbelltown Hospital for example, where our treating teams going out into the communities deliver some services in spaces which are more suitable and for those communities.
“And we saw hybrid models of care throughout the pandemic as well – a mixed delivery of services which has been beneficial, especially for women with diabetes who are concerned about how medicalised their pregnancy is going to be.
“If there’s any options for making care more accessible or equitable, like the option of the hybrid model of care, that would be most beneficial.”
Support for your practice
SWSPHN will run a POLAR report for interested practices in our region, to identify patients diagnosed with diabetes who are of childbearing age. The report will help develop a recall list, enabling you to engage those patients in discussions about pre-pregnancy planning and contraception. Our diabetes co-ordinator Alyssa Horgan is available to visit practices to assist in setting up a recall process.