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Background Despite numerous publications stating the importance of multidisciplinary care for women with pre-existing medical conditions, there is a lack of evidence regarding structure or processes of multidisciplinary working, nor impact on maternal or infant outcomes. This study aimed to evaluate the implementation of guidelines for multidisciplinary team (MDT) management in pregnant women with pre-existing diabetes or cardiac conditions. These conditions were selected as exemplars of increasingly common medical conditions in pregnancy for which MDT management is recommended to prevent or reduce adverse maternal and fetal outcomes. Methods National on-line survey sent to clinicians responsible for management or referral of women with pre-existing diabetes or cardiac conditions in UK National Health Service (NHS) maternity units. The survey comprised questions regarding the organisation of MDT management for women with pre-existing diabetes or cardiac conditions. Content was informed by national guidance. Results One hundred seventy-nine responses were received, covering all health regions in England (162 responses) and 17 responses from Scotland, Wales and Northern Ireland. 132 (74%) related to women with diabetes and 123 (69%) to women with cardiac conditions. MDT referral was reportedly standard practice in most hospitals, particularly for women with pre-existing diabetes (88% of responses vs. 63% for cardiac) but there was wide variation in relation to MDT membership, timing of referral and working practices. These inconsistencies were evident within and between maternity units across the UK. Reported membership was medically dominated and often in the absence of midwifery/nursing and other allied health professionals. Less than half of MDTs for women with diabetes met the recommendations for membership in national guidance, and although two thirds of MDTs for women with cardiac disease met the core recommendations for membership, most did not report having the extended members: midwives, neonatologists or intensivists. Conclusions The wide diversity of organisational management for women with pre-existing diabetes or cardiac conditions is of concern and merits more detailed inquiry. Evidence is also required to support and better define the recommendations for MDT care.

Questionnaire. Iodine Knowledge Questionnaire. Copy of questionnaire provided in study. (PDF 125 kb)

Vitamin D deficiency is a common occurrence globally, and particularly so in pregnancy. There is conflicting evidence regarding the role of vitamin D during pregnancy on non-skeletal health outcomes for both the mother and the neonate. The aim of this study was to investigate the associations of maternal total 25-hydroxy vitamin D (25OHD) with neonatal anthropometrics, and markers of neonatal glycaemia in the Belfast centre of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Serological samples (n=1585) were obtained from pregnant women in the Royal Jubilee Maternity Hospital, Belfast, Northern Ireland between 24–32 weeks gestation as part of the HAPO study. 25OHD concentrations were measured by liquid chromatography tandem mass spectrometry (LC-MS/MS). Cord blood and neonatal anthropometric measurements were obtained within 72h of birth. Statistical analysis was performed. Following adjustment for confounders, birth weight standard deviation scores (SDS) and birth length SDS were significantly associated with maternal total 25OHD. A doubling of maternal 25OHD at 28 weeks’ gestation was associated with mean birth weight SDS and mean birth length SDS higher by 0.05 and 0.07, respectively (both, p=0.03). There were no significant associations with maternal 25OHD and other measures of neonatal anthropometrics or markers of neonatal glycaemia. In conclusion, maternal total 25OHD during pregnancy was independently associated with several neonatal anthropometric measurements; however, this association was relatively weak.

BackgroundGestational diabetes mellitus (GDM) is associated with a 7-fold increased lifetime risk of type 2 diabetes. Excessive gestational weight gain and postpartum weight retention are established predictors of long-term obesity.ObjectiveTo determine the impact of a postnatal lifestyle intervention programme for overweight women with previous gestational diabetes mellitus (PAIGE).DesignPostnatal overweight women with previous GDM participated in a multi-center randomized controlled trial between June 2013 and December 2014. The intervention comprised a one-hour educational programme, a free three-month referral to a commercial weight management organization (Slimming World), a pedometer and structured telephone and text support, in addition to usual care. The control group received usual care only. The primary outcome was weight loss at 6 months.ResultsA total of 60 women were randomized (29 intervention; 31 control) in two centers based on their week of attendance. The intervention group demonstrated significant weight loss at 6 months post-randomization: mean (SD) 3.9(±7.0)kg, compared with the control group: mean 0.7(±3.8)kg, p=0.02. No significant difference was observed in blood glucose levels. With respect to wellbeing measures, a significant reduction in bodily pain was observed in the intervention group (P=0.007).ConclusionsPAIGE resulted in significantly greater weight loss at 6 months compared with usual care. Such weight loss could prove beneficial in terms of better long-term health and subsequent prevention of type 2 diabetes in overweight women with previous GDM. Future interventions need to consider recruitment strategies, timing of the intervention and the inclusion of partners and/or other family members.

Supplemental tables for manuscript titled: Ultrasound-measured visceral adipose tissue depth – a tool for early pregnancy screening for gestational diabetes