Discrete-event simulation of the diabetes and maternity care pathway in a major UK city

Birmingham, the second-largest city in the UK, has one of the highest infant mortality rates in England, with diabetes-related complications during pregnancy identified as a key contributing factor. A multidisciplinary working group comprising clinicians, healthcare practitioners, and operational managers has highlighted several areas for improvement within diabetes-related maternity care. One priority is increasing referrals to the Pre-conception Care (PCC) clinic, which provides specialised clinical advice to individuals with diabetes who are planning a pregnancy. However, concerns were raised regarding the PCC’s limited capacity and the potential impact of increased referrals. This study presents a discrete event simulation model of the diabetes maternity care pathway, developed to evaluate the consequences of varying PCC referral criteria. Using data collected from multiple sources, we assessed the impact of different referral strategies on (i) PCC operational performance, (ii) birth complication rates, and (iii) demand on the diabetes antenatal unit. Our results indicate that, given the current PCC capacity, stringent referral criteria are necessary to avoid overwhelming the clinic. Conversely, broader referral policies could substantially reduce birth complications and alleviate pressure on antenatal diabetes services, highlighting a critical trade-off between clinic capacity and care outcomes.