Management of diabetes and its complications from pre-conception to the postnatal period

National Institute for Health and Clinical Excellence

Key priorities for implementation

Pre-conception care

• Women with diabetes who are planning to become pregnant should be informed that establishing good glycaemic control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. It is important to explain that risks can be reduced but not eliminated
• The importance of avoiding unplanned pregnancy should be an essential component of diabetes education from adolescence for women with diabetes
• Women with diabetes who are planning to become pregnant should be offered pre-conception care and advice before discontinuing contraception

Antenatal care

• If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy
• Women with insulin-treated diabetes should be advised of the risks of hypoglycaemia and hypoglycaemia unawareness in pregnancy, particularly in the first trimester
• During pregnancy, women who are suspected of having diabetic ketoacidosis should be admitted immediately for level 2 critical care, where they can receive both medical and obstetric care
• Women with diabetes should be offered antenatal examination of the four-chamber view of the fetal heart and outflow tracts at 18–20 weeks

Neonatal care

• Babies of women with diabetes should be kept with their mothers unless there is a clinical complication or there are abnormal clinical signs that warrant admission for intensive or special care

Postnatal care

• Women who were diagnosed with gestational diabetes should be offered lifestyle advice (including weight control, diet and exercise) and offered a fasting plasma glucose measurement (but not an oral glucose tolerance test) at the 6-week postnatal check and annually thereafter

full guideline available from…
National Institute for Health and Clinical Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA
guidance.nice.org.uk/CG63

National Institute for Health and Clinical Excellence. National Institute for Health and Clinical Excellence. Management of diabetes and its complications from pre-conception to the postnatal period. Quick Reference Guide. Mar 2008