Designing a new model of care for diabetes in pregnancy in Ireland

If you ask any mother about her pregnancy experience, you will get a different answer and a unique story about what each pregnancy and birth were like. Just like our DNA, no two pregnancies are the same. For women who have or develop diabetes in pregnancy, their journey requires specialised care to ensure both mother and baby are healthy. Diabetes in pregnancy happens for one of two reasons: the mother is already living with type 1 or type 2 diabetes, or she develops gestational diabetes.

Gestational diabetes is diabetes that happens only because the woman is pregnant and normally will ‘go away’ when the baby is born. Even though all three types are called diabetes in pregnancy, how maternity and health services look after women will be different because each type of diabetes is managed differently in pregnancy. All of this means that creating a system for looking after each mother with diabetes in pregnancy is very complex and hard to coordinate! The Irish health service is currently doing that difficult task as it is revising its model of care for diabetes in pregnancy for the next 10-15 years.

Diabetes In Pregnancy Model of Care Working Group

Bump2Baby and Me Project Coordinator, Dr Sharleen O’Reilly, was invited to participate in the Diabetes In Pregnancy Model of Care Working Group as an academic expert. The working group has a team of experts from all areas of care ranging from obstetrics, midwifery, endocrinology, lactation consultancy, general practice, dietetics, physiotherapy, psychiatry, ophthalmology, neonatology, health service planners and clinical psychology. It is a long list but importantly the working group also has patient representatives, who provide the expert voice of the patient in all discussions.

Dr O’Reilly explains: “The discussions around gestational diabetes care were the most debated and this shows how challenging delivering care for this group is. This is because it is not a chronic condition like type 1 or 2 diabetes, and though health services are used to delivering diabetes care, gestational diabetes is different. After birth, gestational diabetes doesn’t need to be looked after but the women are at high risk of developing type 2 diabetes, so this needs extra care in the community.”

The final model of care report, to be produced by the working group, will inform higher level health service decisions around funding and building systems to support the model of care delivery in routine maternity and community health services. The report is due to be finalised within the next few months and will hopefully bring better, more woman-centred care into routine health services in the near future.