Diabetes - Pre-Conceptual & Pregnancy Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • All women of child bearing age with Type 1 and Type 2 Diabetes
  • Women who have had previous Gestational Diabetes Mellitus (GDM)

Management

Pre-Pregnancy
  • At each annual review either in primary or secondary care discuss contraception, the importance of planning a pregnancy and pre-conception care. if considering a pregnancy women with type 1 and type 2 diabetes mellitus should contact the practice or their diabetes specialist team
  • Those women planning a pregnancy should be referred to a diabetes pre-conception clinic. Once seen in the clinic the diabetes care plan should include:
    • The importance of blood glucose control pre-conceptually and during pregnancy to reduce risks to mother and baby
    • Review of all medication; the risks and benefits of continuing each medication should be carefully considered. All teratogenic medication should be stopped
    • Advice re the benefits of stopping smoking and referral to smoking cessation if necessary
    • Advice regarding alcohol and substance misuse
    • Dietary advice, including advice and support to maintain or lose weight where indicated
    • Advice about appropriate types of physical activity and health food choices
    • Folic acid supplementation; women with diabetes should be prescribed the higher dose of 5mg folic acid per day
    • Assessment of the presence of any long term complications particularly eye and renal
    • Standard pre-pregnancy assessments as for women who do not have diabetes including rubella status
    • Offer a meter for self-monitoring of blood glucose and advised to test frequently including a mixture of fasting and pre and post prandial
    • The potential risks to mother and baby
Pregnancy Confirmed
  • All Women with type 1 & type 2 who become pregnant should be referred to the Diabetes Specialist team as soon as pregnancy is confirmed
  • Commence 5mg Folic acid once daily immediately
Gestational diabetes mellitus (GDM)
  • Offer an annual HbA1c to women who were diagnosed with gestational diabetes who have a negative postnatal test for diabetes
  • Explain the risks of gestational diabetes in future pregnancies and offer testing for diabetes when planning future pregnancies
  • On confirmation of pregnancy women who have had previous GDM should have an early (14 weeks gestation) Glucose Tolerance Test (GTT) and if positive should be referred to the Diabetes Specialist team as soon as possible. A repeat GTT will be carried out at 24-28 weeks gestation.
All patients with diabetes are seen in a specialist combined clinic staffed by Consultants in diabetes and obstetrics, diabetes specialist nurses, specialist midwife and a dietitian

Referral

Referral Criteria

  • All Women with type 1 & type 2 who become pregnant should be referred to the Diabetes Specialist team as soon as pregnancy is confirmed
  • Woman with previous GDM who have a confirmed pregnancy and a positive GTT should be referred to the Diabetes Specialist team as soon as possible

Referral Instructions

Referrals should be made via fax or telephone to one of the following Diabetes Centres:

Pinderfields General Hospital

Aberford Road

Wakefield

WF1 4DG

Tel: 01924 213904

Fax: 01924 214977

Pontefract General Infirmary

Pontefract

WF8 1PL

Tel: 01977 747930

Fax:01977 747921

Dewsbury and District Hospital

Halifax Road

Dewsbury

WF13 4HS

Tel: 01924 816097

Fax: 01924 816193


Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Evidence/additional information

Assurance & Governance

  • This guidance was developed on: 01.2018
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 01.2018
  • Publication Date: 01.2018
  • Review Date: 01.2020
  • Ref No: END8 - 01.2018
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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