Diabetes - pregnancy
According to the NICE clinical guideline on diabetes in pregnancy, approximately two to five per cent of pregnancies in England and Wales involve women with diabetes. Diabetes in pregnancy increases the risk of obstetric complications and pregnancy in a woman with diabetes can potentially lead to increased complications of diabetes.
This page signposts selected resources on health care issues around diabetes in pregnancy.
The resources were last accessed on 31 October 2012. Some of them are in PDF format – see how to access PDF files.
BUPA: Gestational diabetes (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.
Cochrane Library Database of Systematic Reviews:
Preconception care for diabetic women for improving maternal and infant health
This review found that 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.
Oral anti-diabetic agents for women with pre-existing diabetes mellitus/impaired glucose tolerance or previous gestational diabetes mellitus
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.
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'.
Screening and subsequent management for gestational diabetes for improving maternal and infant health
This review assesses the effects of different methods of screening for gestational diabetes mellitus and maternal and infant outcomes.
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.
Treatments for gestational diabetes
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.
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.
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.
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.
Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type one and two
This study investigated whether progestogen-only, combined estrogen/progestogen or non-hormonal contraceptives differ in terms of effectiveness in preventing pregnancy, in their side effects on carbohydrate and lipid metabolism and in long-term complications such as micro and macrovascular disease, when used in women with diabetes mellitus.
For further information about Cochrane reviews see How to use the Cochrane Library.
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: 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.
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.
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.
NHS Choices: Diabetes 'increases birth defect risk'
It has been known for some time that diabetes in pregnancy is associated with a higher risk of various complications, and this large study provides further evidence on the link between diabetes and birth defects. The study was carried out by researchers from Newcastle University, the Regional Maternity Survey Office in Newcastle, and the South Tees NHS Trust.
NHS Diabetes: Areas of care: Pregnancy
This page is aimed at commissioners and providers of diabetes care. It brings together guidance, policy, commissioning guides, links to care pathways and examples of how pregnancy services can be improved for women with diabetes.
NHS Diabetes (2011) Lead midwife in diabetes: standards, role and competencies (PDF 561KB)
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.
NICE (2008) Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period (CG83)
This clinical guideline 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.
NICE Pathways: Diabetes in pregnancy overview
NICE pathways aim to provide fast access to NICE guidance on a topic and are useful starting-points for those new to a topic. The Pathway covers women of child-bearing age with diabetes and preconception care, and pregnant women without diabetes and screening and diagnosis of gestational diabetes.
NICE quality standard: Diabetes in adults: Quality statement 7: Preconception care
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.
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.
See other specific contexts and populations.