Ministerial Visit to Coombe Hospital
The Minister for Health Dr Leo Varadkar TD visited the Coombe Women & Infants University Hospital recently to launch an important clinical practice guideline and to see first-hand, an initiative aimed at preventing gestational diabetes in pregnant women.
Tackling Gestational Diabetes
The Minister met some of the women taking part in an innovative research study by Professor Michael Turner’s research group which hopes to find a way of preventing gestational diabetes for pregnant women at risk of developing it.
Gestational diabetes occurs in 2.7% of all pregnant women, and with certain risk factors, such as obesity (those with a BMI of 30+) or a family history of diabetes, this figure rises to nearly 17.5%. UCD Research Fellow, Dr Niamh Daly, who is based at the Coombe, told the Minister that the Irish health service could potentially realise maternity savings of €4.35m alone if the study shows that gestational diabetes can be prevented by participating in a ‘positive healthy living’ programme during pregnancy.
The study, which has been partly funded by Friends of the Coombe and is the first of its kind in Ireland, will compare pregnancy outcomes in women who follow the medically-supervised exercise programme, with Facebook support, during their pregnancy and for six weeks afterwards, against standard antenatal care. The aim is to find out whether the exercise group of women will have lower blood sugar levels than non exercising women when they come to have their routine Oral Glucose Tolerance Test (OGTT) at 24-28 weeks gestation. Amongst other outcomes being studied are the mothers’ weight and body composition during the pregnancy, food intake patterns and post natal depression. Outcomes for the baby include studying the birth weight, whether the baby needed to be admitted to the Neonatal Intensive Care Unit (NICU) after birth, and the baby’s weight and body composition at six weeks.
Dr Daly said:
“The aim of preventative medicine is to protect, promote and maintain health, and to prevent medical complications. This might be achieved during pregnancy by targeting modifiable risk factors, for example, smoking, obesity, or an unhealthy diet and lifestyle. We know from previous research that women who develop gestational diabetes are more likely to require medical treatment and induction of labour or delivery by caesarean section. The cost of caring for women with gestational diabetes is also fifty per cent higher than the cost of caring for women with uncomplicated pregnancies. These women are also seven times more likely to develop type 2 diabetes in later life. Fetal complications can occur and the baby is at risk of becoming obese as he or she grows up, or developing type 2 diabetes.”
“We know that people’s predisposition to diabetes is determined in the womb, so babies born to women who developed gestational diabetes are far more likely to develop diabetes later in life.”
Dr Sharon Sheehan, Master of the Coombe told the Minister:
“The study is a very simple approach to finding a way of preventing a condition which is on the increase, and one which has huge long-term implications for both mother and baby. The research involves 120 pregnant women between now and 2016 who will take part in a tailor-made exercise and healthy eating programme, and who are committed to keeping themselves and their babies well during pregnancy. This is a great opportunity to positively influence the health and wellbeing of the next generation of children and adults.”
“Eradicating gestational diabetes among women with a modifiable risk factor could save the health service almost €2,100 per prevented case in gestational diabetes-related costs alone”
Gestational diabetes in pregnant women means their bodies are unable to produce and use the extra insulin needed for pregnancy. This results in a build-up of glucose in the blood, and therefore high blood sugar levels. The extra glucose in the blood goes through the placenta and also gives the baby high blood sugar levels and requires the baby to produce additional insulin. As the amount of glucose the baby gets is more than it needs for normal growth, the excess ends up being stored as fat, resulting in a bigger baby.
Clinical Practice Guidelines
At the same visit, Dr Leo Varadkar TD also formally launched new a Clinical Practice Guideline on Bacterial Infections Specific to Pregnancy. The guideline, which is intended for healthcare professionals, particularly those in training, who are working in HSE-funded hospitals and primary care, was developed under the auspices of the National Clinical Programme in Obstetrics and Gynaecology led by Professor Michael Turner (UCD Professor of Obstetrics and Gynaecology at Coombe Women & Infants University Hospital) and his team. The guideline has been endorsed by the Institute of Obstetricians and Gynaecologists and by the HSE.
Concern about maternal death due to sepsis has re-emerged in developed countries. In Ireland too, there have been concerns about individual maternal deaths. In order to help prevent sepsis in the maternity setting, the focus of the guideline is on the primary infection, specifically the prevention and management of pregnancy-specific bacterial infections.
Minister Varadkar said:
“It’s important that Ireland has a maternity service in which women and their families can place their trust. That’s why it’s crucial to develop guidelines like the Clinical Practice Guideline on Bacterial Infections Specific to Pregnancy. This guideline was developed through the National Clinical Programme in Obstetrics and Gynaecology led by Professor Michael Turner, and endorsed by the Institute of Obstetricians and Gynaecologists and by the HSE. One of my priorities in 2015 is to extend our suite of National Clinical Effectiveness Guidelines. My Department has published the first six national guidelines which is a critical step to delivering consistent, safe, evidence-based care across the country.”
“Pregnancy, particularly around the time of delivery, is a time of vulnerability from infection for women because of physiological changes in the woman’s immune system and cardiovascular system. This guideline and the introduction of the Irish Maternity Early Warning (IMEWS) highlight the need for vigilance and early diagnosis in pregnant women with an infection. Maternal sepsis is uncommon in Ireland and we must continue to prioritise both prevention and effective treatment. This guideline is intended to support the clinical judgement of all staff responsible for the care of women and their babies during and immediately after pregnancy,” said Professor Michael Turner, Director of the UCD Centre for Human Reproduction at the Coombe.
The guideline is one of a suite of over 30 guidelines that have been developed by the National Clinical Programme over the last five years to further improve the quality of maternity care in Ireland. The development of the guideline was one of the recommendations made in the HIQA investigation into the safety, quality and standards of services provided by the HSE to patients, including pregnant women, at risk of clinical deterioration, and in particular to address the need for new guidelines on infection and pregnancy.
The guideline serves as an introduction to a suite of clinical guidelines which addresses infection in pregnancy, and puts an emphasis on the prevention of pregnancy-specific bacterial infections in the first instance. Related guidelines targeting specific infections in pregnancy are under development and are due to be published later in 2015.
Professor Robert Harrison, Chairperson of the Institute of Obstetricians & Gynaecologists said:
“This is an important guideline, which will support the decision making of those caring for patients in our 19 maternity units. We look forward to the publication of additional multidisciplinary guidance in the future.”
Irish Maternity Early Warning System (IMEWS)
IMEWS is a nationally agreed scoring system developed for early detection of life threatening illness in hospital in-patient care in obstetric and gynaecological services of a woman with a confirmed clinical pregnancy and up to 42 days in the postnatal period.
The guideline was first published as an obstetrics and gynaecology clinical programme guideline in June 2013. The guideline was then developed further to become a National Clinical Guideline assured by the NCEC, and launched by the Minister for Health, Leo Varadkar, at an event in Dublin Castle in November 2014.
The guideline may be downloaded from the following link. The HSE website for Clinical Programme for Obstetrics & Gynaecology is:
Caption (thumbnail) Dublin, 2nd April 2015; Minister for Health Leo Varadkar TD and Professor Michael Turner, Director of the UCD Centre for Human Reproduction at the Coombe, discussing the Clinical Practice Guideline - Bacterial Infections Specific to Pregnancy. The Minister was on a visit to the hospital and took the opportunity to welcome the publication of the guideline.
Picture above: Dublin, 2nd April 2015; Minister for Health Leo Varadkar, TD, with Master of the Coombe Women and Infants University Hospital Dr Sharon Sheehan, (centre) and Dr Niamh Daly (right, holding Niomh Cowley Kelly, nine months) at the Coombe Education Centre. The Minister was visiting the Coombe to observe a supervised exercise class taking place as part of the ‘positive healthy living’ programme being carried out in the centre, which is specifically designed to prevent gestational diabetes.
The programme is being led by UCD research fellow Dr Niamh Daly as part of a study at the Coombe to examine the effects of healthy living by pregnant women at high risk of developing gestational diabetes. The study is the first of its kind to be carried out in Ireland and measures the impact of positive lifestyle changes, such as healthy eating and supervised exercise classes on the blood sugar levels of pregnant women who have a body mass index equal to, or more than 30.