Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period

Date published:  March 2008 (revised reprint July 2008)
State: Published

Approximately 650,000 women give birth in England and Wales each year, and 2-5% of pregnancies involve women with diabetes.  Approximately 87.5% of pregnancies complicated by diabetes are estimated to be due to gestational diabetes (which may or may not resolve after pregnancy), with 7.5% being due to type 1 diabetes and the remaining 5% being due to type 2 diabetes. The prevalence of type 1 and type 2 diabetes is increasing. In particular, type 2 diabetes is increasing in certain minority ethnic groups (including people of African, black Caribbean, South Asian, Middle Eastern and Chinese family origin).

Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes. In addition, diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (such as hypoglycaemia) are more common in babies born to women with pre-existing diabetes.

Guidance on the following aspects of care will be provided:

  • Preconception information
  • Diagnosis and management of gestational diabetes
  • Glycaemic control in the preconception, antenatal and intrapartum periods
  • Changes to medications for diabetes and its complications before or during pregnancy
  • Management of diabetic emergencies (for example, hypoglycaemia and ketoacidosis) and diabetic complications (such as retinopathy) during pregnancy
  • The timetable of antenatal appointments to be offered to women with diabetes
  • Timing and mode of birth (including induction of labour, caesarean section, analgesia and anaesthesia, and the use of steroids for fetal lung maturation)
  • Initial care of the newborn baby
  • Management of diabetes and its complications during the postnatal period

For general enquiries about this guideline please e-mail: enquiries@ncc-wch.org.uk.

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GDM screening model (Diabetologica 2010) 

Diabetologica paper

GDM screening model  - cost utility of different strategies (Excel 2007)

Instructions for GDM screening model

 

Updated 9th September, 2010