Barriers to pre-conception care have been identified by NICE (2008) as lack of pregnancy planning, sociocultural factors, misconceptions and lack of knowledge, attitudes of health care providers towards pregnancy, lack of social support, appropriateness and availability of services, and younger age. Services should therefore be arranged that acknowledge and aim to reduce these barriers.
The workforce needs to be appropriately resourced and skilled to provide care to women with established diabetes and for those developing gestational diabetes. This will include coordination and appropriate transfer of care between primary care teams, specialist diabetes services (physician, diabetes nurse specialist and diabetes specialist dietitian), obstetricians, and midwives according to local guidelines.
International guidelines recommend pre-conception and perinatal care is provided by an experienced multidisciplinary team, composed of diabetes nurse educators (in New Zealand diabetes nurse specialists), midwives, (diabetes specialist) dietitians, obstetricians and diabetologists. Care provided in this way has been shown to minimise maternal and foetal risks in women with diabetes (ADIPS 2005; SIGN 2010; Canadian Diabetes Association 2013) (see Standard 16).
