BMJ  2008;336:714-717 (29 March), doi:10.1136/bmj.39505.641273.AD

Practice

Guidelines

Management of diabetes from preconception to the postnatal period: summary of NICE guidance

The first 150 words of the full text of this article appear below.

Why read this summary?

Diabetes in pregnancy is associated with risks to the woman (for example, higher rates of miscarriage, pre-eclampsia, and preterm labour) and to the developing fetus and baby (for example, higher rates of congenital malformations, macrosomia, birth injury, and perinatal mortality).^{1 2} This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to manage diabetes and its complications from preconception to the postnatal period.³

Recommendations

NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Preconception information for women with pre-existing diabetes

• From adolescence onwards, advise women about the importance of avoiding unplanned pregnancy. [Based on a high quality national clinical audit]
  
• Inform women and their families about how diabetes affects pregnancy and how pregnancy affects diabetes . . . [Full text of this article]

Box 1 Effects of diabetes on pregnancy and effects of pregnancy on diabetes
Information and advice for women with diabetes and their families should cover the following points
For women with pre-existing diabetes information and advice should also cover the following points
Glycaemic control before and during pregnancy
The safety of medications for diabetes and its complications before and during pregnancy
Management of diabetic emergencies and complications during pregnancy
Box 2 Retinal and renal assessment for women with pre-existing diabetes
Gestational diabetes
Box 3 Risk factors for determining testing for gestational diabetes in routine antenatal care
Antenatal care appointments
Box 4 Specific care for women with diabetes during pregnancy
Preterm labour in women with diabetes
Timing and mode of birth
Glycaemic control during labour and birth
Initial assessment and care of the newborn baby
Box 5 Criteria for admission to neonatal unit
Postnatal management of diabetes
Pre-existing diabetes
Gestational diabetes

Overcoming barriers

Further information on the guidance
Background
What’s new?
Methods
Key areas for future research

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