# Pre-conception — expectations of NHS



## Highnoon (May 10, 2021)

Hi all,

My wife (T1) and I are looking to conceive our first child in the next few months and want to do everything we can to ensure a healthy pregnancy. We're both from different backgrounds (the USA and New Zealand) and are trying to get to grips with what is/isn't offered on the Scottish NHS.

She has reached out to the GP, who has refused to do any blood tests (incl. a recommended test on thyroid function) since she is otherwise healthy. Instead, the GP said to contact the local diabetes team with extra questions. The diabetes team said since her A1c is good (last measured 18+ months ago — "no need to get it retested"), there isn't any need for an appointment and to go back to the GP with any specific questions. They even said there is no need to take folic acid before pregnancy, despite the NHS's own website (and US/NZ counterparts) recommending folic acid pre-conception.

I don't want to sound ungrateful, and I understand that US healthcare is quite "extra" and unnecessary; BUT, it seems like the GP and diabetes team don't want to do any tests or provide any information ahead of time. There are even other little things, like the US doctors recommending a toxoplasmosis test (since we have several cats), but the GP here saying that it isn't offered. The doctors in the US also recommend blood panels and an eye test, but the diabetes team/GP don't think any tests are needed. The conflicting information is very confusing!

My questions are:

Should we be getting more from the GP/diabetes team or are we just expecting different things based on overseas experiences? 
Are there avenues outside the NHS to get extra reassurance/care? E.g. private endocrinologist, testing, etc.?
Have you had a pregnancy with Type 1 diabetes? What was your experience?
Thank you all so much.


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## Inka (May 10, 2021)

High dose folic acid is most *definitely* recommended in the U.K.! I’ve had 3 pregnancies with Type 1. Could it be her GP just doesn’t know much about it? She might be prescribed mini dose aspirin too. I was.

She should phone her hospital diabetes team - ie consultant and DSNs and say she’s trying to conceive. They’ll prescribe - or tell the GP to prescribe - the 5mg folic acid. Theyll also probably ask for up to date blood tests to check her HbA1C and other things.

My experience of pregnancy was that I got a lot of support and care - extra scans, extra appointments, care for me and baby in a Transitional Ward after delivery, etc. I was very impressed with all the care I got.


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## Inka (May 10, 2021)

I meant to say that the mini aspirin was to reduce the risk of pre-eclampsia.


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## Highnoon (May 10, 2021)

Inka said:


> High dose folic acid is most *definitely* recommended in the U.K.! I’ve had 3 pregnancies with Type 1. Could it be her GP just doesn’t know much about it? She might be prescribed mini dose aspirin too. I was.
> 
> She should phone her hospital diabetes team - ie consultant and DSNs and say she’s trying to conceive. They’ll prescribe - or tell the GP to prescribe - the 5mg folic acid. Theyll also probably ask for up to date blood tests to check her HbA1C and other things.
> 
> My experience of pregnancy was that I got a lot of support and care - extra scans, extra appointments, care for me and baby in a Transitional Ward after delivery, etc. I was very impressed with all the care I got.


Thanks so much for your reply! We did manage to get 5mg of folic acid through the GP which is great. We spoke to the diabetes team today and they said they don't usually get involved pre-conception and any diabetes discussions should be made with the midwife and obstetrician *after* we've conceived. We pushed them on this and they reluctantly said they would talk to the diabetes consultant and get back to us but that they thought it wasn't necessary before we conceive. It is a bit frustrating since she hasn't had her Hba1c checked since 2019 and it seems to be difficult to get much more from them at this stage. 

This all runs counter to the experience you and others have described to us, so we'll definitely keep pushing to see what else they can do. Thank you again!


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## Inka (May 10, 2021)

If her control is good they should at least do an HbA1C just to see her starting point even if they don’t want to see her in clinic. My control was good but I’d had a recent HbA1C so knew all was ok. I then phoned the Pregnancy DSN as soon as I got a positive test. I was then seen by a multi-discipline team at 7wks. There was my diabetes consultant, OB,midwife, DSN, etc.


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## trophywench (May 10, 2021)

Most of us don't have personal experience of the NHS in Scotland - think it's usually very good if you're close enough to certain hospitals.  However Scottish NHS has long had a service known as 'My diabetes My way' which a good many of us English and Welsh individuals have wished was available to us so you might try investigating that whilst you're hunting.

I think some services like preconception advice may have fallen by the wayside during the pandemic - but her GP should surely to hell be arranging for the normal annual tests (like HbA1c, 'toe tickling', retinopathy photos etc) wherever you happen to live in the UK?


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