Diabetes in pregnancy
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Diabetes in pregnancy. Implementing NICE guidance. 2 nd edition – March 2012. NICE clinical guideline 63. Guideline review . Guideline issue date: 2008 First review : 2011 2011 review recommendation The guideline should be updated.

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Diabetes in pregnancy

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Using this template

Diabetes in pregnancy

Implementing NICE guidance

2nd edition – March 2012

NICE clinical guideline 63


Guideline review

Guideline review

  • Guideline issue date: 2008

  • First review : 2011

  • 2011 review recommendation

  • The guideline should be updated.

  • The consultation on the scope will take place in March/April 2012. The publication date for the updated guideline has not been confirmed.


What this presentation covers

What this presentation covers

  • Background

  • Risks of diabetes in pregnancy

  • Key priorities for implementation

  • Costs and savings

  • Discussion

  • NHS Evidence and NICE Pathway

  • Find out more


Background prevalence

Background: prevalence


Risks of diabetes in pregnancy

Risks of diabetes in pregnancy


Key priorities for implementation

Key priorities for implementation

  • Pre-conception care

  • Antenatal care

  • Neonatal care

  • Postnatal care


Pre conception care 1

Pre-conception care: 1

  • Inform women with diabetes who are planning to become pregnant that establishing good glycaemic control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death.

  • It is important to explain that risks can be reduced but not eliminated.


Pre conception care 2

Pre-conception care: 2

The importance of avoiding unplanned pregnancy should be an essential component of diabetes education from adolescence for women with diabetes.

Offer pre-conception care and advice to women with diabetes who are planning to become pregnant before discontinuing contraception.


Antenatal care 1

Antenatal care: 1

If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy.

Advise women with insulin-treated diabetes of the risks of hypoglycaemia and hypoglycaemia unawareness in pregnancy, particularly in the first trimester.


Antenatal care 2

Antenatal care: 2

  • Admit pregnant women who are suspected of having diabetic ketoacidosis immediately for level 2 critical care where they can receive both medical and obstetric care.

  • Offer women with diabetes antenatal examination of the four-chamber view of the fetal heart and outflow tracts at 18–20 weeks.


Antenatal care 3

Antenatal care: 3

At the booking appointment screen for risk factors

associated with gestational diabetes.

Offer testing for gestational diabetes if any

one risk factor identified.


Neonatal care

Neonatal care

  • Keep babies of women with diabetes with their mothers unless there is a clinical complication


Postnatal care

Postnatal care

Offer women who were diagnosed with gestational diabetes:

  • lifestyle advice

  • a fasting plasma glucose

    measurement


Costs and savings per 100 000 population

Costs and savings per 100,000 population

This slide also includes costs and savings for implementing the

NICE guidance on antenatal care

Costs correct at March 2008.

Costs not updated for 2nd edition


Discussion

Discussion

  • How can we promote pre-conception services to support women with diabetes to plan for pregnancy?

  • How can we ensure women with risk factors for gestational diabetes are identified?

  • What more do we need to do to ensure appropriate referrals are made to joint diabetes and antenatal clinics?

  • What should we be doing to ensure that we are providing annual follow up of lifestyle advice and fasting blood glucose testing to women diagnosed with gestational diabetes?


Nice pathway

NICE Pathway

  • The NICE Diabetes in pregnancy Pathway covers.

Click here to go to NICE Pathways website


Nhs evidence

NHS Evidence

To be added- the latest NHS evidence image

Visit NHS Evidence for the best available evidence on all aspects of diabetes.

Click here to go to the NHS Evidence website


Find out more

Find out more

  • Visit www.nice.org.uk/CG63 for:

    • other guideline formats

    • costing report and template

    • audit support

    • online educational tool


What do you think

What do you think?

  • Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice?

  • We value your opinion and are looking for ways to improve our tools. Please complete this short evaluation form.

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