Diabetes and Pregnancy
(Consensus statement prepared by the Primary Care Diabetes Nurse Network: 2015)
All women with diabetes who are contemplating pregnancy should ideally be referred for specialist preconception and antenatal care.
The possibility of pregnancy should be discussed at each diabetes consultation.
Preconception Care:
Antenatal Care:
1. Refer for specialist preconception care.
2. Start Folic Acid 5mg once daily.
3. Encourage diet & lifestyle modification /
refer to dietician.
4. Replace/discontinue teratogenic*
medications.
5. Achieve tight glycaemic control.
6. Screen for complications.
7. Avoid conception until good glycaemic
control achieved.
1. Refer for specialist multi-disciplinary
care.
2. Screen for diabetes complications.
3. SMBG 7 times a day.
4. Maintain normoglycaemia.
5. Close fetal surveillance.
6. Deliver in unit with neonatal care
facilities.
Post Natal Care:
1.Resume pre pregnancy insulin dose.
2.Commence suitable OHAs/ insulin
if breastfeeding (Type 2 diabetes).
3. Where possible keep baby with mother.
4. Discuss future pregnancies and contraception.
5. Discuss diet and lifestyle.
Pre Conception Blood Glucose & HbA1c Targets:
Pre Meal & Pre Bed
3.5 - 5.0mmol/L
1hr Post Prandial
<7.0 mmol/L
SMBG should be performed 7 times a day. Pre meals,1hr post meals and before bed.
HbA1c should be as low as possible without excessive hypoglycaemia.
Treatment options for women with Type 2 diabetes include Metformin* or insulin or both.
The risk of hypoglycaemia and hypoglycaemic unawareness should be explained to all women on insulin treatment.
Hypoglycaemic unawareness is common in the first trimester.
Pregnancy Blood Glucose & HbA1c Targets:
Pre Meal & Pre Bed
3.5 - 5.0mmol/L
1hr Post Prandial
<7.0mmol/L
SMBG should be performed 7 times a day. Pre meals, 1hr post meals and before bed.
HbA1c should be as low as possible without excessive hypoglycaemia.
Screening for Gestational Diabetes:
If GDM is suspected at any gestation – perform OGTT immediately. Identified at risk women should be screened for GDM between 24-28 weeks
gestation
Diagnosis of Gestational Diabetes Mellitis with 75g 2hr OGTT:
The following criteria are specific to pregnancy.
A diagnosis is made when one or more values are met or exceeded:
Fasting
1hr
2hr
5.1mmol/L
10.0mmol/L
8.5mmol/L
1. If negative between 24-28 weeks continue routine antenatal care.
2. Repeat OGTT if GDM suspected later in pregnancy.
3. If negative at an earlier gestation, repeat OGTT at 24-28 weeks.
If Positive refer for combined Obstetric care
1. Educate regarding diet, lifestyle modification and diabetes management.
2. Monitor glycaemic control.
3. Plan of care as for Type 1/ Type 2 once on insulin therapy.
Ketone test strips should be prescribed and explained for use in the event of illness, hyperemesis or hyperglycaemia
Post Partum Management of Women with Gestational Diabetes:
Perform 75g OGTT at 6 weeks postpartum
Post Natal Advice
The WHO diagnostic criteria is used for a 75g OGTT carried out at 6 weeks post partum.
If positive refer to an Endocrinologist.
If negative perform OGTT yearly thereafter.
1. Risk of Type 2 diabetes in future
2. Risk of GDM in future pregnancies
3. Diet and lifestyle modification
4. Normoglycaemia prior to all future
pregnancies
Interpretation of Results
of 75g OGTT
Normal
Fasting
2hr post 75g glucose
<5.6mmol/L
<7.8mmol/L
Impaired
Fasting
Glucose
5.6 -6.9
<7.8
Impaired Diabetes
Glucose
Tolerance
<7.0
≥7.0
7.8 - 11.0 ≥11.1
Notes:
 *Teratogenic medications include statins, ace inhibitors, angiotensin receptor blockers and most oral hypoglycaemic agents.
 *Metformin use in pre pregnancy and pregnancy: Please consult your local Diabetes clinic for advice .
Taken from July 2010 Guidelines for the Management of Pre Gestational and Gestational Diabetes from Pre Conception to the Post Natal Period
Office of the Nursing & Midwifery Services Director, Quality & Clinical Care Directorate, Health Service Executive, Dr Steevens’ Hospital, Dublin 8, Ireland
There is an app available for women with pre pregnancy diabetes and gestational diabetes. Go to www.whatsupmum.ie/diabetes