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A NICE guideline is born!

Debbie Hicks

Diabetes during pregnancy is associated with risks to the prospective mother and to the developing foetus. Complications such as miscarriage, pre-eclampsia and pre-term labour are more common in women with diabetes than those without the condition. Also, complications such as 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.

Approximately 650000 women in England and Wales give birth each year, with 2–5% of pregnancies involving women with diabetes (King, 1998; Confidential Enquiry into Maternal and Child Health [CEMACH], 2003). Some 87.5% of pregnancies complicated by diabetes are estimated to be due to gestational diabetes, 7.5% are attributed to type 1 diabetes and the remainder due to type 2 diabetes (CEMACH, 2003).

The recently published NICE guideline on diabetes in pregnancy (2008) outlines recommendations for the management of diabetes and its complications in those women with diabetes who are pregnant or wish to conceive. The guideline focuses on areas where additional or different care should be offered to women with diabetes and their babies and builds on existing clinical guidance for routine care during the antenatal, intrapartum and post-natal periods.

Where made possible by supporting evidence, the guideline makes separate recommendations for women with pre-existing diabetes and women with gestational diabetes. Everyone of child-bearing age, including young women who have not yet transferred from paediatric to adult services are referred to as ‘women’. A summary of the main points from the guidance can be found in Box 1.

It is imperative that high-quality preconception, antenatal and post-natal care is available to all women of child-bearing age with diabetes, or those in whom diabetes occurs at any point during the pregnancy, throughout the UK, to avoid repeating the poor outcomes as documented in the CEMACH report in February 2007.

Diabetes during pregnancy is associated with risks to the prospective mother and to the developing foetus. Complications such as miscarriage, pre-eclampsia and pre-term labour are more common in women with diabetes than those without the condition. Also, complications such as 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.

Approximately 650000 women in England and Wales give birth each year, with 2–5% of pregnancies involving women with diabetes (King, 1998; Confidential Enquiry into Maternal and Child Health [CEMACH], 2003). Some 87.5% of pregnancies complicated by diabetes are estimated to be due to gestational diabetes, 7.5% are attributed to type 1 diabetes and the remainder due to type 2 diabetes (CEMACH, 2003).

The recently published NICE guideline on diabetes in pregnancy (2008) outlines recommendations for the management of diabetes and its complications in those women with diabetes who are pregnant or wish to conceive. The guideline focuses on areas where additional or different care should be offered to women with diabetes and their babies and builds on existing clinical guidance for routine care during the antenatal, intrapartum and post-natal periods.

Where made possible by supporting evidence, the guideline makes separate recommendations for women with pre-existing diabetes and women with gestational diabetes. Everyone of child-bearing age, including young women who have not yet transferred from paediatric to adult services are referred to as ‘women’. A summary of the main points from the guidance can be found in Box 1.

It is imperative that high-quality preconception, antenatal and post-natal care is available to all women of child-bearing age with diabetes, or those in whom diabetes occurs at any point during the pregnancy, throughout the UK, to avoid repeating the poor outcomes as documented in the CEMACH report in February 2007.

REFERENCES:

Confidential Enquiry into Maternal and Child Health (CEMACH; 2003) Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002–03, England, Wales and Northern Ireland. CEMACH, London
CEMACH (2007) Diabetes in pregnancy: are we providing the best care? Findings of a national enquiry: England, Wales and Northern Ireland.  CEMACH, London
King H (1998) Epidemiology of glucose intolerance and gestational diabetes in women of childbearing age. Diabetes Care 21(Suppl 2): B9–13
NICE (2008) Diabetes in pregnancy: Management of diabetes and its complications from preconception to the postnatal period. NICE, London. Available at: http://www.nice.org.uk/nicemedia/pdf/CG063FullGuidance.pdf

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