The management of pregnant women with diabetes

Diabetes UK

All women with pre-existing diabetes

  • Pre-pregnancy counselling should be offered to all women with diabetes at all possible times
  • Women on oral hypoglycaemic agents (apart from metformin) or whose HbA1c is above normal should be started on insulin before conception or in unplanned pregnancy as soon as pregnancy is confirmed
    – women with HbA1c>10% (86 mmol/mol) should be advised to avoid getting pregnant
  • A 5 mg dose of folic acid should be started (ideally 3 months) pre-conception and continued to 12 weeks gestation
  • Women should be given healthy eating advice that is in line with that given to all women with diabetes
  • As early as possible the woman with diabetes should be seen in a combined clinic by a team including an obstetrician with a special interest in diabetes and pregnancy, a physician, a specialist diabetes dietitian, a specialist diabetes nurse and a specialist midwife
    • the woman (and her partner) should be included as members of the team and given sufficient appropriate information to make choices about her care
  • Blood glucose levels should be monitored frequently and insulin adjusted accordingly:
    • goals for self-monitored blood glucose levels should be set jointly with the woman
    • levels of HbA1c should be below 6.1% (43 mmol/mol), but for women at risk of hypoglycaemia 7.5% (56 mmol/mol)
      • capillary whole blood glucose:
        before meals <5.9 mmol/l
        1 hour after meals <7.8 mmol/l
      • capillary plasma glucose:
        before meals 4.4–6.1 mmol/l
        1 hour after meals <8.6 mmol/l
    • all women diagnosed with pre-existing diabetes, or with gestational diabetes, should test glucose levels before breakfast and 1 hour after every meal during pregnancy

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