The recent CEMACH report provides important information on outcomes and processes of care for pregnancy complicated by pre-gestational diabetes in England,Wales and Northern Ireland. Similar information for Scotland was published previously by the Scottish Diabetes in Pregnancy Study Group. The Confidential Enquiry into Maternal and Child Health found that maternal diabetes was associated with increased rates of stillbirth (4·7-fold), perinatal mortality (3·8-fold), and congenital anomaly (2-fold), compared to pregnancy not complicated by diabetes. Assessment of rates of pre-pregnancy counselling (documented in 34·5%), measurement of HbA1c in early pregnancy (38%) and pre-conception folic acid supplementation (39·2%), suggest areas where service development might be concentrated to improve outcomes. Finally, CEMACH provides the first large-scale survey of an increasingly prevalent patient group – women with type 2 diabetes in pregnancy – who made up 27·2% of the survey and showed similar adverse outcomes to the women with type 1 diabetes.
