The Management of Pre-existing and Gestational Diabetes in
Pregnancy before, during and after delivery
Content
Section
Content
1.0
Rational for guidelines
2.0
Aims
3.0
6.0
Antenatal
3.1 Antenatal Care
3.2 Timing of appointments
3.3 Individualised Management
3.3 management of unwell antenatal diabetics
3.4 protocol for administration of antenatal steroids to
patients with diabetes or gestational diabetics
Management of diabetic during labour
4.1 management of diabetes during labour – details
instructions
Obstetric management of women with pre-existing
and gestational diabetes
5.1 Labour special circumstances
Monitoring compliance
7.0
Evidence
8.0
Provenance
4.0
5.0
Page
1
1.0 RATIONALE FOR GUIDELINE
The National Service Framework for Diabetes (2002-2003) 1, and the Confidential
Enquiry into Maternal and Child Health Report on Diabetes in Pregnancy (CEMACH
Diabetes 2005)2, has clearly set out the vision of care for pregnant women with
diabetes. The publication of the clinical guideline for the management of preexisting diabetes and its complications for preconception to the postnatal period by
NICE in March 2008 has taken these findings through to an evidence based clinical
guideline3. The recommendations within these reports form the basis behind the
development of this guideline. They include the provision of a service delivered
jointly by a designated Consultant obstetrician with a special interest in diabetic
pregnancy care, and an adult diabetic team consisting of a Consultant diabetologist,
a diabetes specialist nurse (DSN), and diabetes dietitian with midwifery support.
This guideline covers the management of women with pre-existing diabetes in
pregnancy and gestational diabetes. It should be used in conjunction with
section 3.1 ‘Pattern of Antenatal Care’ of the Leeds Teaching Hospitals
’Guidelines and Protocols relating to the Provision of Antenatal Care’
2.0 AIMS
The aim of this guideline is to outline the pathway of care for women with preexisting and gestational diabetes for the antenatal, intrapartum and postpartum
period in order to achieve a good outcome for mother and baby. It should be used
by all health care professionals caring for diabetic women in pregnancy, labour and
the postpartum period.
3.0 ANTENATAL
3.1 ANTENATAL CARE
All women with pre-existing diabetes are offered counselling and information
regarding how diabetes affects pregnancy and pregnancy affects diabetes in a
preconception clinic run jointly by the adult diabetes team and consultant
obstetrician. The aim of this clinic is to prepare the woman for pregnancy with a
target HbA1c level of 6.1% prior to conceiving. Women are offered individualised
dietary advice and education regarding the role of diet, body weight and exercise,
and carbohydrate management. Individualised weight loss advice is offered to all
women who have a BMI>27 kg/m2 as per NICE clinical guideline on the
management of obesity4. They are also counselled about the importance of folic
acid 5mgs daily whilst trying to conceive. In view of the tight control aimed for
preconception and during pregnancy women are given advice about the prevention
and treatment of hypoglycaemia and hypoglycaemia unawareness in pregnancy.
Women seen in the diabetes preconception clinic are monitored to assess any
complications of diabetes including retinopathy and nephropathy and the
appropriate referral made to other specialists if required.
At the diagnosis of pregnancy the woman is transferred to the joint diabetes
antenatal clinic where she is cared for by a multidisciplinary team of consultant
obstetricians and diabetic physicians as well as diabetes specialist nurses, and
diabetes dietitians.
2
Multidisciplinary Team and contact details:
LGI

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
Dr Jennifer Brewster (Consultant Obstetrician) - Secretary 26829 or via switchboard
LGI
Dr Sarah Winfield (Consultant Obstetrician) – Secretary 22657 or via switchboard
SJUH
Dr Eleanor Scott (Consultant Diabetologist) - contactable via switchboard LGI
Diabetes Specialist Nurse – ext 22954
Diabetes dietitian - 23231
Midwife
SJUH
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Dr Daisy Koh (Consultant Obstetrician) - contactable via switchboard SJUH
Dr Medha Rathod (Consultant Obstetrician) – contactable via switchboard SJUH
Dr Stephen Gilbey (Consultant Diabetologist) - contactable via switchboard SJUH
Diabetes Specialist Nurse – ext 65068
Diabetes dietitian - 65069
Midwife
The following is the minimal timetable of antenatal appointments. Women will be
seen more frequently by the diabetic team or obstetric team depending on their
clinical need which is assessed each time they attend clinic in order to individualise
their care.
3.2 TIMETABLE OF ANTENATAL APPOINTMENTS (MINIMUM REQUIRED):
Women with pre-existing diabetes are seen as soon as possible in the combined
diabetic antenatal clinic. Women with pre-existing diabetes will be regularly
followed up by the diabetic team (usually every 1-2 weeks) for the duration of
their pregnancy to ensure they are adequately supported to achieve good
glycaemic control. Women with gestational diabetes are usually diagnosed at 2627 weeks and will follow the pattern of antenatal care outlined below from 28 weeks.
Gestational diabetics diagnosed at any other time will follow the pathway of
antenatal care outlined below from the time of diagnosis with the exception of fetal
echo which they do not require. The timetable of antenatal appointments outlined
below specifies specific care that should take place at a given gestation in addition
to the regular review of diabetes management.
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Gestation
Before
weeks
Who with
10 CMW
1st trimester Obstetric review
(as soon as
possible
once
referral
received)
Diabetic team
review
16 weeks
Obstetric review
Diabetes review
18-20
weeks
Obstetric review
Diabetes review
Action
Booking Appointment
 Complete Antenatal booking and risk assessment
 Refer to Diabetic clinic
 Dating scan to be booked for <10 weeks
 Discussion regarding options for serum
screening.
 Booking bloods - as per routine antenatal care
 Discussion about the obstetric management of
diabetes in pregnancy including monitoring of
fetal well-being and the importance of good
glycaemic control for neonatal outcomes
 Review of medications and alteration to
medication safe to use in pregnancy if required
 Assessment of other obstetric risk factors.
 Discussion regarding postnatal care of baby
including early feeding and monitoring of blood
glucose levels in the first 24 hours of life.
 Ensure on high dose folic acid (5mgs)
 Booking BP and urinalysis
 Booking BMI.
 Discussion of glycaemic targets – aiming for
fasting blood sugar below 5.5 and 1 hour postprandial level of below 7.5mmol/L.
 Review of diabetes control, and confidence with
carbohydrate management.
 Diabetes dietician review of carbohydrate
management skills, weight gain and adequacy of
nutrition for pregnancy
 Assessment of diabetes complications – retinal
screening, nephropathy.
 Review of medication.
 Advice on risks of hypoglycaemia unawareness,
prevention, treatment and use of glucagon and
concentrated glucose solutions.
 Retinal assessment and renal assessment if not
had in the last 12 months
Information leaflet ‘Pre-existing diabetes and pregnancy’
should be given at booking visit.
Review booking blood tests. Discuss and book anomaly
scan and fetal echo. Discuss antenatal screening if not
yet undergone any screening.
Retinal screening for women identified as having
retinopathy in the first trimester.
 anatomy scan and fetal echo (4 chamber view of
fetal heart and outflow tracts)
 BP and urinalysis.
 Review of gylcaemic control / assessment of
complications.
 Maternal weight measurement
4
25 weeks
28 weeks
30 weeks
32 weeks
34 weeks
36 weeks
38 weeks
Obstetric review
clinical examination, BP and urinalysis
(primips only)
Obstetric review
 Ultrasound scan for growth and liquor.
 Check FBC. Anti-D if rhesus negative.
Diabetic review
 Retinal screening.
 Maternal weight measurement
Midwifery review
 BP/urine.
 Discussion regarding breast-feeding and
postnatal care of neonate.
Joint
antenatal
ultrasound scan for growth and liquor volume.
clinic review
Midwifery review
 Discussion with midwife regarding breastfeeding
and birth-plan and initial care of baby.
 Maternal weight measurement.
Diabetic review
Including discussion with diabetes dietician and diabetes
specialist
nurse
regarding
breastfeeding
and
carbohydrate/insulin adjustment.
Joint
antenatal
ultrasound scan for growth and liquor volume
clinic review
Obstetric issues
Planning mode and timing of delivery. The plan for
delivery is to consider and offer induction of labour from
38 weeks as per the NICE guideline. This will be
individualised depending on maternal and fetal wellbeing and discussed with a Consultant Obstetrician in
the clinic before booking. The aim is for all women to
achieve a vaginal delivery assuming there are no
obstetric contra-indications. Caesarean section may be
considered for diabetic women whose fetus is estimated
weight is predicted to be greater than 4.5kgs due to the
risk of shoulder dystocia in this group5 and will be
decided by the Obstetric Consultant.
Diabetic Issues
Discussion with woman regarding the postnatal
management of her diabetes. Discussion/ information
regarding breastfeeding and diabetes and the effect of
breastfeeding on diabetes control. All women will be
encouraged to breastfeed.
Definition: ‘Joint antenatal clinic review’ includes review by an obstetrician,
diabetologist, and diabetes specialist nurse and diabetes dietitian.
3.2 INDIVIDUALISED MANAGEMENT
During the course of their pregnancy, all diabetic women will have an individualised
management plan developed and filed in their hand-held notes which covers
pregnancy and the postnatal period (up to 6 weeks). This will address:
 targets for glycaemic control
 frequency of review in the multidisciplinary clinic
 additional tests to monitor mother for diabetic complications e.g. retinal
screening
 frequency and nature of fetal monitoring
 timing and mode of delivery
 need for thromboprophylaxis
 diabetic control post-delivery and during breastfeeding
 postnatal contraception
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The plan must include details of who to contact should problems arise during the
pregnancy and in the six weeks afterwards.
3.3 MANAGEMENT OF THE UNWELL ANTENATAL DIABETIC WOMAN.
Women with diabetes who present unwell in pregnancy should be reviewed by a
senior obstetrician (ST3 minimum). It is important to be aware of the risks of
diabetic ketoacidosis (DKA) and this should be excluded by testing the urine for
ketones with/without an arterial blood gas in all women who present unwell and are
known to be diabetic. Triggers for DKA include hyperemesis, infection and
reluctance of women with diabetes to increase their insulin adequately. If a woman
is diagnosed with diabetic ketoacidosis she should be transferred to delivery suite
for High Dependency Unit monitoring and CTG monitoring. If there are concerns
about fetal well-being on CTG monitoring the maternal condition should be
stabilised before considering delivery. Often improvement in the maternal condition
will be reflected by an improvement in the CTG. The principles of management are
the same as the management of DKA outside of pregnancy and involve aggressive
fluid resuscitation with IV insulin therapy. Additional considerations in pregnancy
include the use of tinzaparin thromboprophylaxis and assessment of fetal wellbeing. Up to 1/3 women with DKA in pregnancy have a normal blood glucose
level and this does therefore not preclude the diagnosis. Urgent medical
review should be sought from the on-call diabetes team.
Women with diabetes are used to regularly checking their blood glucose level and
will usually prefer to continue checking their sugars themselves whilst in-patients. If
the woman is unwell and not able to check her own glucose level this should be
done by a member of staff. If a woman has had treatment for a high or low blood
glucose level it is important that the midwifery staff ensure she has rechecked her
blood glucose to ensure that the treatment has been effective (please see section
3.3 diabetes complications). If she is unable to this should be done by the midwifery
staff.
3.5 PROTOCOL FOR ADMINISTRATION OF ANTENATAL STEROIDS TO
PATIENTS WITH DIABETES OR GESTATIONAL DIABETES
Steroid administration can cause a rise in blood glucose and may precipitate
ketoacidosis. All patients, whatever their treatment, should be admitted to the
antenatal ward for monitoring. All patients should be discussed with the diabetes
team, preferably pre-admission. There is always a consultant on call for diabetes at
St James’s – contact ward 28 (65728) to identify who it is if not already known at
admission.
3.5.1 Patient on insulin treatment
The diabetes team will advise if patients on insulin can stay on their subcutaneous
insulin (with doses increased by at least 50% during the period of steroid
administration) or whether they should be started on intravenous insulin at the time
of admission.
IF IN DOUBT START ON INTRAVENOUS INSULIN REGIME AS PER THE
LEEDS HOSPITALS INSULIN PRESCRIPTION CHART WITH IV FLUIDS AND
BLOOD GLUCOSE MONITORING HOURLY AS PER INTRAPARTUM CARE
PLAN (page 6 of this guideline).
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3.5.2 Patients on diet or metformin treatment
The diabetes team can advise whether subcutaneous insulin should be initiated
immediately. All patients should have blood glucose measured and ketones
monitored (as below). If glucoses rise to above 10 mmol/L and/or ketones detected
intravenous insulin should always be started and medical advice sought.
METFORMIN should then be STOPPED for the duration of steroid treatment and
until medical advice sought.
3.5.3Monitoring
All patients should have their blood glucose measured a minimum of 4 times a day
(pre-breakfast and one hour after each meal). Urine should be monitored for
ketones and blood ketones checked if 1) the patient feels unwell and in particular
has nausea and vomiting, 2) if urine ketones positive or 3) if blood glucoses
persistently above target 3) Measure serum bicarbonate and biochemistry if patient
unwell
Target blood glucose values are 4-5.5 mmol/L premeals, <7.5 mmol/L one hour
post-meals.
3.5.4 Action to be taken
1. If a patient is on subcutaneous insulin and blood glucoses rise to above
target levels
If the patient is well and urine/blood ketones negative: insulin doses may need
adjustment – contact diabetes team unless a plan for adjusting doses already in
place. If the patient is unwell and/or urine/blood ketones positive: start intravenous
insulin, seek medical advice to discuss management as potential diabetic
ketoacidosis following the hospital protocol
2. If patient is on metformin or diet and glucoses start to rise or ketones
positive. Start intravenous insulin and seek medical advice as to whether
ketoacidosis protocol should be followed.
IF IN DOUBT ALWAYS TREAT AS POTENTIAL KETOACIDOSIS
AND SEEK MEDICAL ADVICE.
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4.0 Management of diabetes during labour (to be completed by 34/40 gestation)
Type of diabetes:
Patient sticker (or details)
Intrapartum IV Insulin/Dextrose infusion.








The aim is to keep the blood glucose levels between 4-8mmol/l throughout active labour or caesarean section.
Capillary blood glucose needs checking and recording hourly (record on insulin chart).
Start 5% glucose at 80 mls/hour.
Start IV insulin (50 units of soluble insulin actrapid or humulin S) in 50 mls of 0.9% sodium chloride via a syringe driver at the rate determined by hourly capillary
glucose measurements.
The insulin regime should be prescribed as per the trust insulin prescription forms which are kept on both delivery suites, ward 57 and antenatal ward at SJUH.
This should run in conjunction with the IV glucose at 80 mls/hr as above. One should not continue or be prescribed without the other in a fasting diabetic
pregnant patients.
Blood glucose levels should be recorded on the insulin chart.
Medical review of insulin prescription should take place after 2-6 hours initially and then 6 hours after any rate changes. If obstetric doctors are unsure regarding
the insulin prescription advice must be sough from the medical registrar on call. Please follow advice on adjusting insulin rates on page four of the insulin
prescription chart.
If on sliding scale for more than 12 hours check urea and electrolyte level.
Post delivery medication - Box 1
Diabetic Complications:
 Inform Diabetic team about delivery (Diabetes Specialist Nurse contact details below)
 If patient experiencing hypoglycaemia and they are eating and drinking please give them: 120ml of lucozade by mouth
 If patient experiencing hypoglycaemia and they are NBM or vomiting give: 30-50mls of 50% glucose IV via antecubital fossa through grey venflon, or
1mg glucagon injection IM.
 In all cases repeat blood glucose after 15 minutes to ensure it remains above 3.5 mmol/l.
 If blood glucose is over 12 mmol/l for more than one readings please contact the diabetic team see last page (during office hours) or the medical ST
3/4/5 on call (out of hours)
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4.1 Management of diabetes during labour – detailed instructions
Type 1
diabetic on
Insulin
Type 1
diabetic on
CSII Insulin
pump
Type 2 or
gestational
diabetic on
Insulin
Type 2 or
gestational
diabetic on
Insulin and
Metformin
Type 2 or
gestational
diabetic on
Metformin
Type 2 or
gestational
diabetic on
diet only
Spontaneous labour
or IOL
Day before elective section
Morning of
elective section
After delivery
Once in established
labour discontinue S/C
insulin and start IV
insulin/glucose
Continue short acting insulin
(novorapid/humalog) with meals
but halve long acting insulin
(lantus/detemir/ insulatard). If
on pre-mixed insulin bd
(Novomix) halve the evening
meal dose.
Continue with pump.
Start IV insulin,
glucose at 6am.
Halve IV insulin rate but continue IV glucose for 2 hours, in recovery. If
persistent vomiting, keep IV insulin/glucose going. Once fit for transfer
discontinue IV insulin/glucose and give toast and tea with short acting
insulin (novorapid/ humalog) or first dose of pre-mixed insulin
(Novomix) and restart insulin regime as suggested in Box 1.
Once on transitional ward monitor blood glucose pre-meals for the
duration of their stay.
Halve IV insulin rate but continue IV dextrose for 2 hours, in recovery.
If persistent vomiting, keep IV insulin/glucose going. Once fit for
transfer patient can recommence S/C insulin pump (see Box 1) and
once commenced IV insulin/glucose can then be discontinued.
Once on transitional ward monitor blood glucose pre-meals for the
duration of their stay.
Halve IV insulin rate but continue IV glucose for 2 hours, in recovery. If
persistent vomiting, keep IV insulin/glucose going. Once fit for transfer
discontinue IV insulin/glucose and give toast and tea with insulin and
restart treatment as suggested in Box 1.
Once on transitional ward monitor blood glucose pre-meals for the
duration of their stay. If gestational diabetic, will need fasting glucose
at GP at 6 week postnatal check, and thereafter yearly – please
ensure this is requested in discharge letter.
Halve IV insulin rate but continue IV glucose for 2 hours, in recovery. If
persistent vomiting, keep IV insulin/glucose going. Once fit for transfer
discontinue IV insulin/glucose. Give toast and tea. Restart treatment as
directed in Box 1. Once on transitional ward monitor blood glucose
pre-meals for the duration of their stay.
If gestational diabetic, will need fasting glucose at GP at 6 week
postnatal check, and thereafter yearly – please ensure this is
requested in discharge letter.
Stop any IV insulin/glucose. Give toast and tea.
Once on transitional ward monitor blood glucose in Type 2 diabetic
pre-meals for the duration of their stay. Restart any treatment as
directed in Box 1. Stop blood glucose monitoring in gestational
diabetics unless advised to by diabetic team. If gestational diabetic, will
need fasting glucose at GP at 6 week postnatal check, and thereafter
yearly – please ensure this is requested in discharge letter.
Stop any IV insulin/glucose. Give toast and tea. Stop blood glucose
monitoring in gestational diabetics unless advised to by diabetic team.
If gestational diabetic, will need fasting glucose at GP at 6 week
postnatal check, and thereafter yearly – please ensure this is
9
requested in discharge letter.
Once in established
labour discontinue S/C
insulin pump and
immediately start IV
insulin/glucose
Stop S/C insulin
pump &
immediately
commence IV
insulin/glucoseat
6am
Start IV insulin and
glucose at 6am
Once in established
labour discontinue S/C
insulin and start IV
insulin/glucose
Continue short acting insulin
(novorapid/humalog) with meals
but halve long acting insulin
(lantus/detemir/ insulatard). If
on pre-mixed insulin (Novomix)
halve the evening dose.
Once in established
labour discontinue S/C
insulin and metformin
and start IV
insulin/glucose
Continue short acting insulin
(novorapid/humalog) with meals
but halve long acting insulin
(lantus/detemir/ insulatard). ). If
on pre-mixed insulin bd
(Novomix) halve the evening
meal dose. Continue metformin
until nil by mouth.
Continue metformin until nil by
mouth.
Start IV insulin/
glucose at 6am
Normal diabetic diet. No
changes needed.
Monitor blood
glucose hourly. If
blood glucose
>8mmol/l
commence IV
insulin/glucose
Once in established
labour discontinue
Metformin and monitor
blood glucose hourly. If
blood glucose >8mmol/l
commence IV
insulin/glucose
Monitor blood glucose
hourly. If blood glucose
>8mmol/l commence IV
insulin/glucose
Monitor blood
glucose hourly. If
blood glucose
>8mmol/l
Start IV
insulin/glucose
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5.0 Obstetric management of women with pre-existing and
gestational diabetes
Planned preterm delivery
If a woman is being delivered prematurely for obstetric indications due to the high
risk of neonatal respiratory distress women should receive antenatal steroids if
delivery is being planned prior to 36 weeks gestation. Please see section 3.3 of
guideline regarding the use of sliding scale insulin.
Threatened preterm labour
If the patient is below 32 weeks there is no contraindication to the use of atosiban
as per the preterm labour guideline assuming there are no other obstetric
contraindications for its use.
Induction of labour
Individualised timing of delivery will be discussed with the patient. The
recommendation is for induction of labour to be offered when the woman has
reached 38 completed weeks. If there are additional fetal or maternal concerns
induction may take place before 38 weeks. Equally if the patient has well controlled
diabetes induction may be deferred to allow a chance of spontaneous onset of
labour. This decision will be made by the obstetric consultants in the antenatal
clinic.
Fetal monitoring - spontaneous onset of labour
Fetuses of women with diabetes are at increased risk of hypoxia and therefore
should be continually monitored with CTG when in active labour. They should have
6 hourly CTGs in the latent phase of labour.
Fetal monitoring - induction of labour
Women should have CTGs prior to prostin and after as per induction of labour
guidelines. Women should then be continuously monitored at onset of contractions
after ARM either spontaneously or with syntocinon. Women can be allowed to
mobilise for 1-2 hours following ARM if their blood sugar is <8. If it is higher than
this a sliding scale should be started.
ST segment analysis (STAN) should NOT be used in any woman with
diabetes.
5.1 Labour - special circumstances
If a woman on a sliding scale at any stage of labour including whilst waiting
for elective caesarean or induction has blood sugar above 10mmol/l she
should be continuously monitored by CTG and insulin regime adjusted as per
the prescription and reviewed by the obstetric registrar or consultant.
Delay in delivery - If delivery is being delayed for any reason daily CTGs
should be performed in the morning whilst waiting as a minimum. The
decision to delay induction/delivery of a diabetic mother should be taken at a
Consultant level. It may be appropriate to delay delivery by 24 hours or may
require transfer to another unit for delivery depending on the individual case.
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Women admitted for elective caesarean section
All women with diabetes having an elective caesarean section should be admitted
the afternoon before for blood glucose monitoring. Please refer to the intrapartum
care plan in the patient’s case-notes. Women should be fasted from midnight and
start sliding scale if required at 6am. In view of the potential for delay of caesarean
section a CTG should be performed first thing in the morning ( before 8am). If there
is any delay in the caesarean section a CTG should be performed 6 hours later
(assuming there are no concerns about high blood sugar then see above).
6.0 Monitoring Compliance
Annual multidisciplinary audit will be carried out in accordance with the Maternity
Services Audit Plan. As a minimum, the case-notes of 20 women with pre-existing
diabetes will be reviewed. Auditable standards will include:



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

Involvement of the multidisciplinary team
Timetable of antenatal appointments
Documentation of individual management plan
Provision of fetal cardiac scan antenatally
Advice given to women re risk of hypoglycaemia / hypoglycaemia unawareness
Admission of women with suspected ketoacidosis to HDU
Audit results will be presented At the Clinical Governance and Risk Management
Audit meeting and disseminated via the Maternity Services Forum, Clinical
Governance and Risk Management Forum, Team Leaders Forum, Supervisor of
Midwives Forum and Maternity newsletter. If any deficiencies or issues are
identified in relation to compliance will be discussed at the Maternity Services
Clinical Governance and Risk Management Forum and a lead midwife and/or
obstetrician will be identified to develop and action plan and monitor progress and
implementation. Action plans will be monitored on an ongoing basis via the
Maternity Services Governance and Risk Management Forum.
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7.0 EVIDENCE BASE
(1) NSF (2001) National Service Framework for Diabetes, Department of Health
(2) CEMACH (2002-2003), Confidential Enquiry into Maternal and Child Health:
Pregnancy in women with Type 1 and Type 2 Diabetes, CEMACH
3) National Collaborating Centre for Women’s and Children’s Health. 2008.
Diabetes in pregnancy. Management of diabetes and its complications from preconception to the postnatal period. NICE Clinical guideline 63, London RCOG
Press.
4) National Collaborating Centre for Primary Care and the Centre for public health
excellence at NICE 2006. Obesity - guidance on the prevention, identification,
assessment and management of overweight and obesity in adults and children.
NICE clinical guideline 43.
5) Rouse DJ, Owen J. Prophylactic caesarean delivery for fetal macrosomia
diagnosed by means of ultrasonography-A Faustian bargain? Am J Obstet Gynecol
1999;181:332–8.
Further readings:
(1) Owens DR et al. Insulins and beyond. 2001. Lancet 358:739-46,
(2) Penny GC et al. A national audit to monitor and promote the uptake of clinical
guidelines on the management of diabetes in pregnancy. 2000. Clinical
perform qual health care 8:28-34.
(3) Johnstone FD. 1999. Gestational diabetes. Current Obstetrics Gynaecology
9;23-28.
(4) Dornhorst A et al. 1998. Diagnosis of gestational diabetes. Editorial Diabetic
Medicine 15:7-10.
(5) Garner P. Type I diabetes and pregnancy. 1995. Lancet 346:157-161.
(6) Jarrett RJ. Gestational Diabetes. 1993. BMJ. 306:37-38.
13
The Management of Pre-existing and Gestational Diabetes in
Pregnancy before, during and after delivery
Author(s)
This guideline was developed by the multidisciplinary team involved in
the care of diabetic women in pregnancy
Contact name
Dr J Brewster (Consultant Obstetrician)
Approval process
Maternity Services Forum (previously
Governance and Risk Management Forum)
First Issue Date
Version no:
Women’s
Services
Clinical
Dec 2009
2.0
Review Date:
Approved and
Ratified by
July 2015
Clinical Governance and Risk Management Forum October 2009
Clinical Guidelines Committee January 2009 (LHP version 1.0)
Amendments approved by MSF 27/07/2012 (LHP version 2.0)
Consultation Process
Maternity Services Guideline Group / Maternity Services Forum, Maternity Services Clinical
Governance and Risk Management Forum/Obstetricians/Team Leaders / Supervisors of Midwives
Scope of guidance
Clinical condition
Patient Group
Professional
Group
Distribution List
Diabetes in Pregnancy
All Diabetic pregnant women booked to deliver within the Leeds teaching
Hospitals NHS Trust
All Health Care Professionals involved in the provision of obstetric care
within the Leeds Teaching Hospitals NHS Trust
All Obstetricians within the Women and Children's Division.
Lead Clinician (Midwifery and Neonates)
Head of Midwifery
Matrons (midwifery and neonatal)
Clinical Midwifery Team Leaders (for distribution to midwives within their
areas)
Dissemination
Via Risk Management Midwife
Audit and
Monitoring
Will be carried out in accordance with Maternity Services Audit Plan
Broad Recommendations
All women should be offered fetal monitoring appropriate to needs and based on best clinical
evidence
Equity and Diversity
Leeds Teaching Hospitals NHS Trust believes in fairness, equity and above all values diversity in
all dealings, both as providers of health services and employers of people. The Trust is committed
to eliminating discrimination on the basis of gender, age, disability, race, religion, sexuality or
social class. We aim to provide accessible services, delivered in a way that respects the needs of
each individual and does not exclude anyone. By demonstrating these beliefs the Trust aims to
ensure that it develops a healthcare workforce that is diverse, non discriminatory and appropriate
to deliver modern healthcare.
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