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Gestational diabetes services inadequate

Guidelines for the management of diabetes in pregnancy are in place but are not being met due to inadequate resources and staffing in maternity hospitals to treat women with the condition.

Dr Ronan Canavan, consultant endocrinologist and Clinical Lead of the HSE National Diabetes Clinical Care Programme, says it is proving difficult for hospitals to meet guidelines without resources.

The deficiencies in care are a huge cause for concern, as uncontrolled gestational diabetes can lead to premature birth, pre-eclampsia, stillbirth, miscarriage and placental abruption. Gestational diabetes is the most common medical disorder in pregnancy and affects 12 per cent of women. In 2014, there were 67,000 births in Ireland.

“There are guidelines in place at the moment but there has been an explosion in gestational diabetes in the last 10 years… What is the point in having good guidelines if you’re not able to even partially address them?” Dr Canavan stated.

He explained the rise in gestational diabetes is due to changes in the threshold for diagnosis, changes in patient population in terms of ethnic mix and obesity, and an ageing maternal population.

It is a priority for the Programme to ensure resources are in place to allow the guidelines to be realistically implemented, and there is a submission to start to address that for 2016, he said.

Diabetic and specialist nursing support is needed and resources are also required in areas where there is no endocrinologist.

The plan is to initially target resources in Dublin’s three maternity hospitals and other hospitals across the country, such as Cork University Maternity Hospital, with high birth rates.

Cork GP and Chair of the Diabetes in General Practice Group (DIGP), Dr Diarmuid Quinlan, confirmed that there are not enough resources to screen all pregnant women in Cork, despite the significant increase in the incidence of gestational diabetes.

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