By Hannah Molloy, Communications Officer, National Screening Service
When women in the midlands with type 1 diabetes discover they are pregnant, clinical midwife manager Amy Farrelly says she is often the first to know. “A few women with type 1 diabetes have rang me before they’ve told their partner!” says Amy, who works in the Diabetes Service Maternity Unit in the Midland Regional Hospital in Mullingar, Co Westmeath.
A midwife for 10 years, Amy always had an interest in diabetes in her work across ante-natal, labour and post-natal care. Following her masters in midwifery management, Amy specialised in diabetes and pregnancy and now works as part of the multidisciplinary team in Mullingar. Amy says: “I look after all the pregnant women who have any kind of diabetes in their pregnancy. That includes ladies with type 1 diabetes, type 2 diabetes, and gestational diabetes.”
Part of Amy’s work is responding to queries that come in from healthcare professionals looking after women with diabetes who are pregnant, and from the women themselves when they find out that they are pregnant or are worried about their glucose levels as their pregnancy progresses.
Amy invites women in for an early scan from which she can provide a rough due date. She also refers women with type 1 and type 2 diabetes on to Diabetic RetinaScreen, Ireland’s free eye screening programme for people with diabetes. “‘You are hoping these women are already registered for diabetic retina screening and are aware of any eye conditions they have, or hopefully there has been nothing found through screening before.” Amy says glucose levels change during pregnancy and if they are not managed for women with diabetes from early on, your eyes can be at risk. “There’s an increased risk to your eyes if glucose levels are not carefully managed in pregnancy, particularly if you have pre-existing diabetic retinopathy.’’
The introduction last year of the initiative to offer more frequent eye screening during pregnancy to all women with type 1 and type 2 diabetes is “brilliant”, Amy says. “As soon as I get a due date I am able to fill in the form and send it off to the Diabetic RetinaScreen team, and I know the women will be offered eye screening.”
Before the new pathway was introduced, Amy says the process for providing women with checks for retinopathy during pregnancy was opportunistic and generally slower. “Now, it is just done. It’s easy and efficient. All you have to do is fill in a form and you know that woman will be invited for their screening test.”
Amy says that when women with diabetes become pregnant, they don’t generally think about their eyes. “They are more worried about the impact of their diabetes on the baby. But the risks for the mammy are just as relevant.”
Amy talks about education being key for women with diabetes during pregnancy, getting glucose levels as best as they can be, being up to date with eye screening, and talking with their diabetic maternity team. Education and virtual clinics play an important role in Amy’s week where she provides information on diabetes care in pregnancy, including attending for diabetic retinopathy screening.
Amy says she has seen an increase in the number of women being diagnosed with type 2 diabetes at their first antenatal visit. “There’s definitely an increase in the number of women who attend for their booking visit and don’t know they have type 2 diabetes,” she says. Part of her role is to make sure that women newly diagnosed with diabetes are cared for throughout their pregnancy, referred to eye screening and given the support they need during their pregnancy.
Amy says a key point about Diabetic RetinaScreen’s service to women during pregnancy is that they are offered screening close to their home. ‘’Women may have trouble getting to appointments or have childcare difficulties” she says ‘’so access is important. It can be the difference between people getting the recommended care or not.”
- You do not need diabetic eye screening if you develop gestational diabetes.
- Ask your diabetes nurse or midwife about eye screening during pregnancy.
- Learn more about eye screening for people with diabetes.
- Our elearning module about Diabetic RetinaScreen aims to increase knowledge about diabetic retinal screening so that health and social care staff can support eligible patients to take part in the screening programme. The module takes around 15 minutes to complete. To access the module, log on to HSeLanD and search for ‘Diabetic RetinaScreen’.