Pregnancy - resources
Here are links to evidence-based resources which support this area of practice. You may also want to refer to information about the national service frameworks and strategies across the UK.
Some of the resources on this page are in PDF format - see how to access PDF files.
Guidelines and guidance
Clinical Resource Efficiency Support Team (CREST) (2001) Management of diabetes in pregnancy (PDF 206.6KB)
These guidelines investigate the high perinatal mortality and malformation rates in babies born to diabetic mothers. A uniform standard of joint diabetic and obstetric specialist care across the province in the management of diabetic pregnancy is proposed.
Confidential Enquiry into Maternal and Child Health (CEMACH) (2007) Diabetes in pregnancy- are we providing the best care. Findings of a National Enquiry (covering England, Wales and Northern Ireland)
This report is one of a series on diabetes in pregnancy. The reports are arranged in date order. The findings suggest that women's preparation for pregnancy, glycaemic control, and the standard of preconception and pregnancy care need to be improved if better pregnancy outcomes are to be achieved for women with diabetes.
Confidential Enquiry into Maternal and Child Health (CEMACH) (2005) Pregnancy in women with type 1 and type 2 diabetes 2002-2003, England, Wales and Northern Ireland
This report is one of a series on diabetes in pregnancy. The reports are arranged in date order. This descriptive study encompassed all pregnancies of women with Type 1 and Type 2 diabetes (diagnosed at least one year before the woman's estimated delivery date) who delivered or booked between 1 March 2002 and 28 February 2003 in England, Wales and Northern Ireland. This included follow-up of pregnancy outcomes 28 days after delivery.
Department of Health (2001) National service framework for diabetes: standard 9 Diabetes and pregnancy
The aim of this standard is "to achieve a good outcome and experience of pregnancy and childbirth for women with pre-existing diabetes and for those who develop diabetes in pregnancy".
Diabetes UK (2008) Care recommendations: Management of pregnant women with diabetes (including Gestational diabetes)
Diabetes UK advises that these recommendations are used in conjunction with usual obstetric practice, and they are specific to the additional requirements that diabetes imposes.
Diabetes UK (2008) Care recommendations: Preconception care for women with diabetes
Provides a summary of main points for women with diabetes considering a pregnancy.
National Institute for Health and Clinical Excellence (NICE) (2008) Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period
This guidance covers the care and treatment of pregnant women with diabetes in the NHS in England and Wales. It also covers the care of their newborn babies. It is written for women who have diabetes or develop it in pregnancy, but it may also be useful for their families or for anyone with an interest in the condition.
NHS Diabetes: Commissioning for diabetes and pregnancy
This is a section within the NHS diabetes commissioning resource which links to a more detailed guidance document. The commissioning guide consists of a description of the key features of good pregnancy and diabetes and an intervention map which describes 'the key high level actions or interventions (both clinical and administrative) pregnancy and diabetes services should undertake to provide the most efficient and effective care'. The guidance is accompanied by a number of case studies.
NHS Diabetes (2011) Lead midwife in diabetes: standards, role and competencies
NHS Diabetes worked with the Royal College of Midwives to publish this 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. The standards are on: access to specialist services; organisational issues; clinical governance; communication; education and training; diabetes specific midwifery practice. The specific midwifery competencies in diabetes in pregnancy are provided in an appendix.
NHS Evidence - diabetes: Diabetes and Pregnancy
There is a section within the library which brings together guidance and pathways, evidences, references, patient information and professional development resources on gestational diabetes and diabetes in pregnancy.
Scottish Intercollegiate Guidelines Network (2010) Management of diabetes: SIGN publication number 116
This guideline provides recommendations based on current evidence for best practice in the management of diabetes. The guideline has a chapter on the management of diabetes in pregnancy.
Systematic reviews and evidence summaries
Bandolier: Diabetes and Congenital Abnormalities
The study estimated that the risk of mothers with diabetes having children with congenital abnormalities was twice as high women without diabetes.
Bandolier: Preconception care lowers risk of abnormalities in infants of diabetics
This meta-analysis aims to assess the effect of preconception care in reducing abnormalities in infants of women with pregestational diabetes.
For more information about Cochrane Systematic Reviews, examples of which appear below, visit the page within this resource on the Cochrane Library.
Cochrane Review: Preconception care for diabetic women for improving maternal and infant health
It is unclear what effect preconception care for diabetic women has on maternal and infant health outcomes based on evidence from randomised controlled trials as only one trial was eligible for inclusion in the review. 'Further large, high-quality randomised controlled trials are needed to evaluate the effect of different protocols of preconception care for women with pre-existing diabetes.'
Cochrane Review: Oral anti-diabetic agents for women with pre-existing diabetes mellitus/impaired glucose tolerance or previous gestational diabetes mellitus
'While most guidelines recommend the use of insulin in women whose pregnancies are affected by pre-existing diabetes, oral agents have obvious benefits for patient acceptability and adherence'. This review aimed to investigate the effect of oral anti-diabetic agents on maternal and infant health in women with pre-existing diabetes mellitus, impaired glucose tolerance or previous gestational diabetes planning a pregnancy or pregnant women with diabetes mellitus.
Cochrane Review: Different intensities of glycaemic control for pregnant women with pre-existing diabetes
'A single trial comparing tight, moderate and loose blood glucose targets found few differences between the tight and moderate groups, although significantly more women in the tight control group had hypoglycaemia in the first half of pregnancy. In the loose control group, significantly more women had pre-eclampsia, and there were significantly more caesareans and large babies'.
Cochrane Review: Screening and subsequent management for gestational diabetes for improving maternal and infant health
Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mother and baby both perinatally and in the long term. This review assesses the effects of different methods of screening for gestational diabetes mellitus and maternal and infant outcomes.
Cochrane Review: Elective delivery in diabetic pregnant women
Induction of labour at 38 weeks pregnancy for women with diabetes treated with insulin lowers the chances of delivering a large baby. The review only found one trial of labour induction for women with diabetes treated with insulin. Induction of labour lowered the number of large babies without increasing the risk of caesarean section.
Cochrane Review: Treatments for gestational diabetes and impaired glucose tolerance in pregnancy
Gestational diabetes and impaired glucose tolerance (IGT) in pregnancy affects between three and six percent of all pregnancies and both have been associated with pregnancy complications. The objective of this review was to compare alternative policies of care for women with gestational diabetes and IGT in pregnancy.
Cochrane Review: Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes
Women who have pre-gestational diabetes have an increasing insulin requirement because of the physiological reduction in action resulting from pregnancy, and this review compares two methods of administering insulin in pregnant women with diabetes.
Cochrane Review: Dietary advice in pregnancy for preventing gestational diabetes mellitus
The objective of the review was to assess the effects of dietary advice in preventing gestational diabetes mellitus.
Cochrane Review: Exercise for diabetic pregnant women
This review aimed to evaluate the effect of exercise programs, alone or in conjunction with other therapies, compared to no specific program or to other therapies, in pregnant women with diabetes on perinatal and maternal morbidity and on the frequency of prescription of insulin to control glycaemia. Also to compare the effectiveness of different types of exercise programs on perinatal and maternal morbidity.
Other resources
BUPA: Diabetes in pregnancy
A factsheet for women who want to know more about diabetes that develops in pregnancy (gestational diabetes). It does not give advice for women who already have diabetes and would like to become pregnant.
Diabetes UK: Pregnancy and diabetes
This section highlights the healthcare issues that need to be considered before and during pregnancy. Answers to some of the frequently asked questions on gestational diabetes are also provided.
March of dimes: Pregnancy complications: Preexisting diabetes
General information on diabetes in pregnancy including pregnancy complications and diet and exercise recommendations. Information about gestational diabetes is also available. The March of dimes is a leading non-profit organisation for pregnancy and childbirth in America.
Go to the pregnancy menu.