Pregnancy

This section is about caring for women who are pregnant and who have diabetes or develop diabetes during their pregnancy:

Introduction

In England and Wales, approximately two to five percent of pregnancies involve women with diabetes (National Institute for Health and Clinical Excellence 2008b). An American study undertaken to assess changes in prevalence of diabetes antedating pregnancy found that over the period of six years (1999 to 2005) the number of pregnant women with diabetes had doubled. Significant increases were observed in all age groups and all racial and ethnic groups but were particularly pronounced amongst younger women. (Lawrence et al 2008; NHS Choices 2008).
 
Gestational diabetes is a form of diabetes that develops during pregnancy but usually disappears when the baby is born. However a woman who has gestational diabetes is at higher risk of developing Type 2 diabetes later in life. Type 2 and gestational diabetes are particularly common in Asian or African-Caribbean women. The NICE guideline provides information and guidance on screening and treatment for gestational diabetes. (National Institute for Health and Clinical Excellence 2008b).
 
The guideline also provides a tabulation of the specific antenatal care for women with diabetes. (National Institute for Health and Clinical Excellence 2008b, page 23). The Scottish guideline emphasises the importance of care being delivered by an experienced multidisciplinary team 'led by a named obstetrician and physician with an interest in diabetes, and including a diabetes specialist nurse, diabetes specialist midwife and dietitian' (Scottish Intercollegiate Guidelines Network 2010, page 56). As a move towards improving the care delivered by midwives, NHS Diabetes, working with the Royal College of Midwives, has also published a document on the standards and competencies for the role and practice of midwives undertaking a midwifery lead in the care of women with diabetes who are pregnant or women who develop diabetes during pregnancy (NHS Diabetes 2011).

Diabetes in pregnancy increases the risk of obstetric complications and pregnancy in a woman with diabetes can potentially lead to increased complications of diabetes. Some of the potential complications and important aspects of pre-pregnancy care and antenatal care are outlined in the key issues section and highlighted in the case study.

References

Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the Reference list.