Gestational Diabetes Mellitus Risk Optimisation in Pregnant Women Prescribed Atypical Antipsychotics: Insights from a Three-Cycle Plan-Do-Study-Act Quality Improvement Project Across South East London
S. Uthayakumar, S. Lewis, A. Qureshi, J. Yasmin, J. Krens, A. DelviIntroduction
South East London (Oxleas) Perinatal Mental Health Services (PMHS) recommend an Oral Glucose Tolerance Test (OGTT) at 14-16 weeks, in addition to the National Institute for Health and Care Excellence (NICE) recommended 28-week OGTT for pregnant women prescribed atypical antipsychotics. Oxleas’ early screening pathway, developed in collaboration with King’s College Hospital NHS Foundation Trust, aims to facilitate earlier identification and management of Gestational Diabetes Mellitus (GDM).
Objectives
This project aims to evaluate current GDM optimisation practices amongst responsible clinicians and midwives, following Standards for Quality Improvement Reporting Excellence guidelines.
Methods
To evaluate baseline documentation practices, a retrospective database audit was conducted on RiO, the Trust’s electronic patient record system, from November to December 2024. Three low-resource, education-focused Plan-Do-Study-Act Cycles followed. Cycle One involved a student-led educational session, followed by questionnaires assessing perinatal psychiatrists’ recall of GDM screening principles i.e., indication, fasting, and NICE vs Trust OGTT timings. Cycle Two involved an infographic prompt (Image 1), distributed to all responsible midwives, with semi-structured interviews assessing effectiveness. Following feedback, the infographic was displayed at all three Oxleas sites and shared with clinicians. Cycle Three revised the Trust’s assessment template to prompt documentation of OGTT booking and results on RiO, at both 14-16 and 28 weeks. Effectiveness will be evaluated in January 2026, by comparing documentation rates in a new cohort of pregnant women on atypical antipsychotics against baseline, accounting for sample size variation.
Results
Of the 47 pregnant women on atypical antipsychotics, 34% (n=16) had a documented 28-week OGTT, result, and management plan. No patient had the Trust-recommended 14-16-week OGTT. After Cycle One, all clinicians (n=5) were able to recall GDM screening principles and 28-week OGTT, but only one clinician recalled the 14-16-week OGTT. Midwife absences limited Cycle Two data, however, two respondents reported that the infographic positively influenced their practice due to prior unfamiliarity with antipsychotic risks and GDM screening.
Image 1: Long description.