NICE have announced the latest clinical guideline on the management of diabetes in pregnancy. Changes from the 2008 version include a lowering of the fasting plasma glucose thresholds for diagnosis of gestational diabetes (GDM; new targets ≥5.6 mmol/L fasting or a 2-hour plasma glucose level of ≥7.8 mmol/L) and new recommendations on self-management for women with type 1 diabetes.
Plasma glucose targets for antenatal care in women with any form of diabetes are 5.3 mmol/L for fasting, 7.8 mmol/L 1 hour after meals and 6.4 mmol/L 2 hours after meals. Updated recommendations for postnatal care relate to women with GDM whose blood glucose levels return to normal after birth. These women should be offered lifestyle advice including weight control, diet and exercise. They should be offered a fasting plasma glucose test 6–13 weeks after the birth and annual HbA1c tests to exclude diabetes. A 75-g 2-hour oral glucose tolerance test should not be routinely offered.
Women with type 1 diabetes who are planning to become pregnant should be offered blood ketone testing strips and a meter, and should be advised to test for ketonaemia if they become hyperglycaemic or unwell.
While the new guidelines may incur additional costs, NICE says these could be offset by potential savings and benefits, such as reduced complications during pregnancy and labour, a reduction in GP and outpatient appointments prior to diagnosis, and improved care for both mother and baby.
The full guidelines can be viewed on the NICE website here.
