Appendix D
Standards of care

 
     

A preconception clinic should be run jointly by the adult diabetes service and the maternity service for women wishing to become pregnant.

[Diabetes NSF – illustrative service models; www.publications.doh.gov.uk/nsf/diabetes/ch2/servicemodels/pregnancy.htm]

Women with diabetes have an increased risk of neural tube defects and should be offered prepregnancy folic acid supplements, continuing up to 12 weeks of gestation.

[CEMACH Diabetes Multidisciplinary Resource Group – standard derived from SIGN Guideline No. 9]

All women with diabetes should be referred promptly for a first-trimester ultrasound scan to enable accurate dating of the pregnancy.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

If delivery is indicated before 34 weeks, administration of corticosteroids should be considered to prevent neonatal respiratory distress syndrome.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

Women should be encouraged and supported to monitor their blood glucose levels regularly and to adjust their insulin dosage, in order to maintain their blood glucose levels within the normal (non-diabetic) range. The aim should be for the woman to maintain her HbA1c below 7.0%.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

Hypoglycaemia should be discussed and glucagon made available with clear instructions on its use.

[CEMACH Diabetes Multidisciplinary Resource Group – standard derived from SIGN Guideline No. 9]

A full retinal assessment should be undertaken in all women with pre-existing diabetes during the first trimester or at booking if this is later.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

Labour and delivery should be undertaken in a maternity unit with facilities for the resuscitation and stabilisation of babies and with personnel skilled in advanced resuscitation immediately available on a 24-hour basis.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

The mode and timing of delivery should be determined on an individual basis, aiming to realise a spontaneous vaginal delivery by no later than 40 weeks of gestation, if possible.

[CEMACH Diabetes Multidisciplinary Resource Group – standard derived from SIGN Guideline No. 9]

Continuous electronic fetal heart monitoring should be offered to all women with diabetes during labour and fetal blood sampling should be available if indicated.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

Intravenous dextrose and insulin should be administered during labour and delivery following an agreed multidisciplinary protocol.

[CEMACH Diabetes Multidisciplinary Resource Group – standard derived from SIGN Guideline No. 9]

All babies should remain with their mothers during the neonatal period unless there is a specific medical indication for admission to a neonatal intensive care unit.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

Babies born to women with diabetes should be fed as soon as possible after birth and all should receive their first feed within 4 hours of birth, unless contraindicated for medical reasons.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

Breastfeeding is recommended but all mothers should be supported in the feeding method of their choice.

[CEMACH Diabetes Multidisciplinary Resource Group – standard derived from SIGN Guideline No. 9]

Babies of mothers with diabetes should have a test of blood glucose concentration by 4–6 hours of age, before a feed.

[Diabetes NSF – Intervention details; www.publications.doh.gov.uk/nsf/diabetes/ch2/interventions/pregnancy.htm]

The diagnosis of hypoglycaemia should be made using a ward-based glucose electrode or laboratory method and not by reagent strip testing.

[CEMACH Diabetes Multidisciplinary Resource Group – standard derived from SIGN Guideline No. 9]

Interventions for the management of hypoglycaemia should be guided by blood glucose level and clinical assessment.

[CEMACH Diabetes Multidisciplinary Resource Group – standard derived from SIGN Guideline No. 9]