Excerpt

This clinical guideline contains recommendations for the management of diabetes and its complications in women who wish to conceive and those who are already pregnant. The guideline builds on existing clinical guidelines for routine care during the antenatal, intrapartum and postnatal periods. It focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1 Diabetes in pregnancy
  • 1.2 Aim of the guideline
  • 1.3 Areas outside the remit of the guideline
  • 1.4 For whom is the guideline intended?
  • 1.5 Who has developed the guideline?
  • 1.6 Other relevant documents
  • 1.7 Guideline methodology
  • 1.8 Stakeholder involvement in the guideline development process
  • 1.9 Schedule for updating the guideline
• 2. Summary of recommendations and algorithm
  • 2.1 Key priorities for implementation (key recommendations)
  • 2.2 Summary of recommendations
  • 2.3 Key priorities for research
  • 2.4 Summary of research recommendations
  • 2.5 Algorithm
• 3. Preconception care
  • 3.1 Outcomes and risks for the woman and baby
  • 3.2 The importance of planning pregnancy and the role of contraception
  • 3.3 Diet, dietary supplements, body weight and exercise
  • 3.4 Target ranges for blood glucose in the preconception period
  • 3.5 Monitoring blood glucose and ketones in the preconception period
  • 3.6 The safety of medications for diabetes before and during pregnancy
  • 3.7 The safety of medications for diabetic complications before and during pregnancy
  • 3.8 Removing barriers to the uptake of preconception care and when to offer information
  • 3.9 Cost-effectiveness of self-management programmes
  • 3.10 Retinal assessment in the preconception period
  • 3.11 Renal assessment in the preconception period
• 4. Gestational diabetes
  • 4.1 Risk factors for gestational diabetes
  • 4.2 Diagnosis of gestational diabetes
  • 4.3 Screening and treatment for gestational diabetes
• 5. Antenatal care
  • 5.1 Target ranges for blood glucose during pregnancy
  • 5.2 Monitoring blood glucose and ketones during pregnancy
  • 5.3 Management of diabetes during pregnancy
  • 5.4 Retinal assessment during pregnancy
  • 5.5 Renal assessment during pregnancy
  • 5.6 Screening for congenital malformations
  • 5.7 Monitoring fetal growth and wellbeing
  • 5.8 Timetable of antenatal appointments
  • 5.9 Preterm labour in women with diabetes
• 6. Intrapartum care
  • 6.1 Timing and mode of birth
  • 6.2 Analgesia and anaesthesia
  • 6.3 Glycaemic control during labour and birth
• 7. Neonatal care
  • 7.1 Initial assessment and criteria for admission to intensive or special care
  • 7.2 Prevention and assessment of neonatal hypoglycaemia
• 8. Postnatal care
  • 8.1 Breastfeeding and effects on glycaemic control
  • 8.2 Information and follow-up after birth
• Appendix A Declarations of interest
• Appendix B Clinical questions
• Appendix C Cost-effectiveness of self-management programmes for women with diabetes who are planning a pregnancy
• Appendix D Cost-effectiveness of screening, diagnosis and treatment for gestational diabetes
• Appendix E Cost-effectiveness of screening for congenital cardiac malformations
• References
• Search strategies
• Evidence tables

(revised reprint July 2008)

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.