Pregnant women with diabetes are at high-risk and need special care before, during and after pregnancy. Optimal attention for these women has been a priority at the Cuban Ministry of Public Health since the 1960s and is one of the priority tasks of the National Programme for Maternity and Infant Care in Cuba.
This has led to the development of the National Comprehensive Diabetes and Pregnancy Program comprising clinical, educational and research activities throughout Cuba at all care levels for reproductive-age women, that is from 15 to 49 years, with diabetes mellitus (DM) whether pregnant or not; and women with gestational diabetes, meaning glucose intolerance that appears during pregnancy, GD.
In Cuba, the prevalence of perinatal mortality and congenital malformations is 7 and 9%, respectively, in children of women with diabetes. These high prevalence rates could be avoided if the women received treatment before and during their pregnancy. Therefore, there is a need to ensure appropriate health care to pregnant women with diabetes.
Pre-conception care for diabetic women has two fundamental objectives: to prevent congenital abnormalities, and to detect DM complications, some of which are contra-indications to pregnancy, and managing treatable ones to reduce risk prior to conception. During pregnancy, chronic DM complications predating conception should be monitored every trimester.
In Cuba, all pregnant women with one or more GD risk factors should be identified at primary care level. Risk factors include age (over 30 years), family history of DM, history of GD, history of previous large babies, history of unexplained fetal death after 34 weeks, overweight or obesity, and high blood sugar during pregnancy. Women at risk are given a fasting blood sugar test at 24 weeks' gestation and an oral glucose tolerance test between the 28th and 32nd weeks.
Gestational diabetes occurs in between 2 and 9 percent of all pregnancies. Women who develop this condition are also at a higher risk of developing diabetes in later life. In addition, their babies tend to be larger than average when they are born, which can lead to difficulties during birth -- including injury to the baby, according to researchers.
Over the last five years there has been a major push at strengthening care for gestational diabetes in Cuba at a cost of over 3.5 million euros. This project was completed in collaboration with the 'World Diabetes Foundation'.
Six diabetes and pregnancy service clinics at major hospitals were modernised and 12 more established, covering all Cuba. 130 new doctors, nurses and paramedics have been trained. More than 28,000 pregnant women have been screened for gestational diabetes and have been given improved care due to the nationwide establishment and modernisation of diabetes and pregnancy services.
The most recent data available show that in infants born to pre-gestational diabetic women who received specialized pre-conception care, the number of perinatal deaths has decreased to 0.8% and the number of congenital malformations has decreased to 0.9% .
This is an intense national diabetes and pregnancy program and aims to provide diabetic women with quality care prior to and during pregnancy. The work is ongoing and new goals continue to be set, such as accurately identifying the reproductive-age population of diabetic women, increasing the percentage of diabetic women receiving pre-conception care, and increasing GD screening. These actions, which will improve the health and quality of life for diabetic women and their children, are at the center of attention of the Cuban state's universal and free of charge health system.
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