Management of Diabetes in Pregnancy
Prepregnancy care
- Optimise glycaemic control - target HbA1c <7%
- Change oral hypoglycaemics to insulin (keep on Metformin if PCOS but stop once pregnancy confirmed)
- Screen for microvascular complications (retinopathy and nephropathy)
- Screen for thyroid dysfunction
- Stop teratogenic drugs eg ACE inhibitors and Statins
- For BP control - use methyl dopa
- Prescribe Folic acid 5mg OD
- Discuss maternal and foetal risk
Antenatal Care
Women should be referred to the joint diabetes antenatal clinic as soon as pregnancy is confirmed. Women are usually seen every 2-4 weeks until the third trimester when they are seen at least fortnightly. Folic acid 5mg OD should be continued until 14 weeks
Glycaemic control:
Encourage to check BM's at least 4 times a day (preprandially and prebed)
Target: 4-7mmol/l
Monthly HbA1c - target <7%
Dietary advice
Most women (particularly type 1 DM) will require a basal bolus insulin regimen
Give advice regarding hypoglycaemia and ketoacidosis
Give glucagon injection and instructions on usage
Screening for microvascular complications
Refer to ophthalmology as soon as pregnancy confirmed - ideally should be seen at each trimester for fundoscopy
Urine dipstick for protein at each visit
If persistent proteinuria (++), then monthly:
Consider Aspirin therapy (75mg OD) from 14 weeks in presence of proteinuria
Blood pressure
Aim for BP<140/80
Use methyldopa
Consider Aspirin therapy (75mg OD)
Obstetric screening
Women should be referred to the joint diabetes antenatal clinic as soon as pregnancy is confirmed. Women are usually seen every 2-4 weeks until the third trimester when they are seen at least fortnightly. Folic acid 5mg OD should be continued until 14 weeks
Glycaemic control:
Encourage to check BM's at least 4 times a day (preprandially and prebed)
Target: 4-7mmol/l
Monthly HbA1c - target <7%
Dietary advice
Most women (particularly type 1 DM) will require a basal bolus insulin regimen
Give advice regarding hypoglycaemia and ketoacidosis
Give glucagon injection and instructions on usage
Screening for microvascular complications
Refer to ophthalmology as soon as pregnancy confirmed - ideally should be seen at each trimester for fundoscopy
Urine dipstick for protein at each visit
If persistent proteinuria (++), then monthly:
MSU
24 hour urine protein
U&E and S. creatinine
Consider Aspirin therapy (75mg OD) from 14 weeks in presence of proteinuria
Blood pressure
Aim for BP<140/80
Use methyldopa
Consider Aspirin therapy (75mg OD)
Obstetric screening
| Ultrasound | Bloods |
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Care during labour
The timing of delivery is individualised and providing that diabetes is well-controlled and there are no maternal or foetal complications then pregnancy may be continued until 39-40 weeks.
50% of women with diabetes will require a Caesarean section
Follow 'diabetes in labour' guidelines
The timing of delivery is individualised and providing that diabetes is well-controlled and there are no maternal or foetal complications then pregnancy may be continued until 39-40 weeks.
50% of women with diabetes will require a Caesarean section
Follow 'diabetes in labour' guidelines
Post natal care
Reduce insulin dose to prepregnancy levels or convert back to oral hypoglycaemics in women with Type 2DM when eating and drinking but do not use oral hypoglycaemics if breast feeding.
Aim for BM's to be 7-10 to initiate breast feeding. May need to reduce insulin doses further once breast feeding
Discuss contraception
6 week postnatal check
Held at the combined diabetes/obstetric clinic
Assess and optimise glycaemic and blood pressure control where appropriate
Discuss future pregnancy planning
Discuss contraception
Book into general diabetes clinic
Reduce insulin dose to prepregnancy levels or convert back to oral hypoglycaemics in women with Type 2DM when eating and drinking but do not use oral hypoglycaemics if breast feeding.
Aim for BM's to be 7-10 to initiate breast feeding. May need to reduce insulin doses further once breast feeding
Discuss contraception
6 week postnatal check
Held at the combined diabetes/obstetric clinic
Assess and optimise glycaemic and blood pressure control where appropriate
Discuss future pregnancy planning
Discuss contraception
Book into general diabetes clinic
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