{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:32:22Z","timestamp":1773898342336,"version":"3.50.1"},"reference-count":34,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute for Health and Care Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care","award":["PR-PRU-1217-21202"],"award-info":[{"award-number":["PR-PRU-1217-21202"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,8]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"\n Objectives<\/jats:title>\n To describe outcomes in women admitted for labour care to midwifery units with gestational or pre-existing diabetes, compare outcomes with other women admitted to the same units and describe admission and care guidance in midwifery units typically admitting women with diabetes.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A national cohort study and a survey of practice.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n We used the UK Midwifery Study System to collect data from midwifery units in the UK between October 2021 and February 2023.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Women with a diagnosis of diabetes admitted for labour care to a midwifery unit were compared with a cohort of women without diabetes admitted for labour care to the same units.<\/jats:p>\n <\/jats:sec>\n \n Primary and secondary outcome measures<\/jats:title>\n The primary outcome was a composite measure of maternal outcome reflecting the need for obstetric care (one or more of augmentation, instrumental birth, caesarean birth, maternal blood transfusion, third or fourth-degree perineal tear, maternal admission to higher level care). We also investigated a number of secondary maternal and neonatal outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Overall, 420 (0.7% (95% CI 0.67% to 0.82%) of the 56\u2009648\u2009women admitted to midwifery units in the study period were recorded as having diabetes, most (84%) with diet-controlled gestational diabetes. Women with diabetes were no more likely than comparison women to experience the composite primary outcome (18.7% vs 20.7%, adjusted relative risk=1.31, 95%\u2009CI 0.96 to 1.80). We found no statistically significant differences between the two groups for the secondary maternal and neonatal outcomes investigated: augmentation, postpartum haemorrhage >1.5\u2009L, shoulder dystocia, maternal blood transfusion and maternal admission for higher level care, Apgar <7 at 5\u2009min, initiation of breast feeding and neonatal unit admission.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The findings of this study provide evidence that selected women with well-controlled gestational diabetes may safely plan birth in midwifery units on the same site as obstetric and neonatal services. With clear admission criteria and careful care planning, access to a midwifery unit provides an opportunity to increase choice, reduce intervention and improve outcomes for these women.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087161","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T22:21:28Z","timestamp":1733264488000},"page":"e087161","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes for women with diabetes admitted for labour care to midwifery units in the UK: a national prospective cohort study and survey of practice using the UK Midwifery Study System (UKMidSS)"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9803-2136","authenticated-orcid":false,"given":"Alessandra","family":"Morelli","sequence":"first","affiliation":[{"name":"NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Smith","sequence":"additional","affiliation":[{"name":"London Ambulance Service NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amar","family":"Karia","sequence":"additional","affiliation":[{"name":"Royal College of Obstetricians and Gynaecologists, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber","family":"Marshall","sequence":"additional","affiliation":[{"name":"Founder, bigbirthas.co.uk, Stonehouse, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Plachcinski","sequence":"additional","affiliation":[{"name":"Independent Parent, Patient and Public Involvement and Engagement Consultant, Dewsbury, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Tyler","sequence":"additional","affiliation":[{"name":"Consultant Neonatologist (Retired), Shrewsbury, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2994-3240","authenticated-orcid":false,"given":"Rachel","family":"Rowe","sequence":"additional","affiliation":[{"name":"NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"2025121510491214000_14.12.e087161.1","unstructured":"World Health Organisation (WHO) . 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