The health of thousands of pregnant women with diabetes and the lives of their unborn babies are threatened by the abrupt withdrawal by the Health Service Executive (HSE) of a scheme designed to protect them from complications of the disease, a leading diabetes specialist has said.
Prof Fidelma Dunne of the department of medicine at the National University of Ireland, Galway, expressed her “outrage” at the decision to unilaterally withdraw the benefits of the long-term illness (LTI) scheme from expectant mothers with diabetes.
The consultant endocrinologist said she was concerned by the lack of discussion and transparency by health authorities with professionals caring for these women and “by the ability of bureaucrats to make bold policy decisions without regard for clinical outcomes and patient safety”.
“The HSE are doing this purely to save money and without regard for patient safety, quality of care and outcomes . . . There will be a catastrophe for a mother or a baby,” she said.
Diabetes affects 12 per cent of pregnant women in the Republic.
Known as gestational diabetes mellitus (GDM), it is linked with increased blood pressure, a dangerous condition called pre-eclampsia and it makes it more likely the mother will require delivery by Caesarean section.
Babies born to mothers with the condition are more likely to suffer breathing problems at birth and to require admission to special care baby units. They are also more likely to be stillborn.
In order to prevent these outcomes, women who develop diabetes in pregnancy require close monitoring of blood sugar levels.
They must test their blood sugar levels seven times a day to achieve the tight control of their diabetes needed to minimise the risk of complications.
The LTI scheme was traditionally used to supply women with free equipment for glucose testing, including monitor strips, lancets and supplies of insulin.
Prof Dunne said that in the absence of these supplies women were faced with paying between €30 and €40 per box of testing strips.
They require a box per week on average, leading to significant additional costs, especially for those in lower socioeconomic groups who experience higher levels of GDM compared with women from more affluent backgrounds.
"The majority simply cannot afford them. Without blood glucose results we cannot make decisions about management and treatment and the need for insulin," she said.
'No clinical support'
In correspondence with the HSE earlier this year, the consultant who acts as the executive's clinical lead for diabetes, Diarmuid Smith, informed a senior administrator its decision "had no clinical support".
“I am still struggling to understand the rationale behind this decision,” he said.
“Women with gestational diabetes who are not allowed to test are more likely to have diabetes pregnancy complications, more likely to have a Caesarean section and longer length of hospital stay.
“Their child is more likely to have complications at birth, more likely to spend time in neonatal ICU and again have a longer length of hospital stay. There is therefore no clinical or economic argument which supports this decision.”
Prof Dunne said the removal of LTI cover for pregnant women with diabetes would result in greater costs to the health service in terms of Caesarean deliveries, neonatal unit care and claims for birth trauma and infant deaths through the clinical indemnity scheme.
A spokeswoman for the HSE said last night that gestational diabetes was not of a permanent or long-term nature and was, therefore, not covered by the LTI scheme.