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Objective To describe recent trends in prevalence, outcomes and indicators of care for women with pre-existing type I or type II diabetes. Design Regional population-based survey. Setting All maternity units in the North of England. Population A total of 1258 pregnancies in women with pre-existing diabetes delivered between 1996 and 2004. Methods Data from the Northern Diabetic Pregnancy Survey. Outcome of pregnancy cross-validated with the Northern Congenital Abnormality Survey and the Northern Perinatal Mortality Survey. Main outcome measures Perinatal mortality, congenital anomaly and total adverse perinatal outcome (perinatal mortality and live births with congenital anomaly). Results The prevalence of pregestational diabetes increased from 3.1 per 1000 births in 1996–98 to 4.7 per 1000 in 2002–04 (test for linear trend, P < 0.0001), driven mainly by a sharp increase in type II diabetes. Perinatal mortality declined from 48 per 1000 births in 1996–98 to 23 per 1000 in 2002–04 ( P = 0.064). There was a significant reduction in total adverse perinatal outcome rate ( P = 0.0194) from 142 per 1000 in 1996–98 to 86 per 1000 in 2002–04. There were substantial improvements in indicators of care before and during pregnancy and in glycaemic control throughout pregnancy, but indicators of preconceptual care, such as use of folic acid, remained disappointing. Conclusion We observed improvements in pregnancy care and outcomes for women with diabetes in a region with an established audit and feedback cycle. There remains considerable scope for further improvement, particularly in periconceptual glycaemic control. The rising prevalence of type II diabetes presents a challenge to further improvement. [ABSTRACT FROM AUTHOR]

In June 2014 Public Health England confirmed a case of Legionnaires' disease (LD) in a neonate following birth at home in a hired birthing pool incorporating a heater and a recirculation pump which had been filled in advance of labour. The case triggered a public health investigation and a microbiological survey of an additional ten heated birthing pools hired or recently hired to the general public across England. The birthing pool used by the parent of the confirmed case was identified as the source of the neonate's infection following detection of Legionella pneumophila ST48 in both patient and environmental samples. Legionella species were detected by quantitative polymerase chain reaction but not culture in a further three pools together with other opportunistic pathogens identified by culture and matrix-assisted laser desorption ionization-time of flight (MALDI-ToF) mass spectrometry. A Patient Safety Alert from NHS England and Public Health England was issued stating that heated birthing pools filled in advance of labour should not be used for home births. This recommendation remains in place. This investigation in conjunction with other recent reports has highlighted a lack of awareness regarding the microbiological safety of heated birthing pools and their potential to be a source of LD and other opportunistic infections. Furthermore, the investigation raised important considerations with regards to microbiological sampling and testing in such incidents. Public health authorities and clinicians should consider LD in the differential diagnosis of severe respiratory infection in neonates within 14 days of a water birth.

Public Health England was notified of Legionnaires' disease in a neonate following a home birth in a heated birthing pool filled from the domestic hot water supply two weeks earlier. We describe the incident, sampling results, and public health actions. It is recommended that heated birthing pools should not be used for home births. Neonates developing pneumonia within 14 days of labour or birth in any birthing pool should be tested for Legionnaires' disease.