In March 2008, NICE issued guidelines providing clear advice to doctors and midwives on how to help women with diabetes manage their diabetes when preparing to conceive, during and after pregnancy.
NICE Guideline recommends that women with pre-exisiting diabetes should access specialist services prior to conception.
Advice should be given about very tight control of blood sugars whilst trying for a baby and during the pregnancy, in those with diabetes. The aim should be for a Fasting Blood Glucose (FBG) of 3.5-5.9 and postprandial blood sugar <7.8 preconception, and during the pregnancy. For some women with Type 2 diabetes this can sometimes mean a switch from oral agents to insulin.
This tight control of blood sugars is to reduce the chance of miscarriage, stillbirth, neonatal death, macrosomic babies and congenital malformation. An HbA1c of < 6.1% significantly reduces the risk of major congenital malformations including cardiac abnormality. An HbA1c of >10% significantly increases the risk of complications.
Women will be offered a four-chamber view of the heart at 18-20 weeks gestation.
Those women who develop gestational diabetes should be given lifestyle advice, but also have a FBG at 6 weeks postnatally, and annually thereafter.
