Thursday 27 Mar 2008 @ 10:21
National Institute for Health and Clinical Excellence (NICE)
National Institute for Health and Clinical Excellence (NICE)
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NICE guideline will help women with diabetes plan for a healthy pregnancy and baby
The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Women’s and Children’s Health yesterday issued guidance providing clear and consistent advice to doctors and midwives on how to help women with diabetes manage their condition when they are preparing to conceive, after they have given birth and in the cycle towards their next pregnancy.
The guideline recommends that women with pre-existing diabetes should access specialist services prior to conception and be given advice on the importance of planning their pregnancy. The guideline also highlights the importance of providing information to women on staying healthy during pregnancy such as by maintaining proper glycaemic control and taking folic acid. This will help to minimise the risks of problems for women with diabetes so that they have the best chance of a good outcome for themselves and their babies.
Key recommendations from the guideline include:
•Women with diabetes who are planning to become pregnant should be informed that establishing good glycaemic control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, of the baby having a malformation at birth, stillbirth and neonatal death.
•Women with diabetes who are planning to become pregnant should be offered pre-conception care and advice before discontinuing contraception.
•If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/l and 1-hour postprandial blood glucose below 7.8 mmol/l during pregnancy.
•Women with diabetes should be offered antenatal examination of the four-chamber view of the fetal heart and outflow tracts at 18–20 weeks.
•
Babies of women with diabetes should be kept with their mothers immediately after birth unless there is a clinical complication or there are abnormal clinical signs that warrant admission for intensive or special care.
•Women who were diagnosed with gestational diabetes should be offered lifestyle advice (including weight control, diet and exercise) and offered a fasting plasma glucose measurement (but not an oral glucose tolerance test) at the 6-week postnatal check and annually thereafter.
Dr Gillian Leng, Deputy Chief Executive, and Executive Lead for this guidance says: “Having a baby is a huge decision for anyone but if you are a woman who has diabetes, it is a decision that requires much more thought and careful planning. We have used the best available evidence from around the world to set a national standard on how midwives and doctors can help women with pre-existing diabetes and gestational diabetes. This guideline will impact on thousands of women and their families and will allow them to prepare adequately so that they have the best possible experience of pregnancy and birth.”
Dr Richard Holt, Diabetes Physician and Guideline Development Group member: “For women with diabetes, planning is the key to having a successful pregnancy so that when they become pregnant they have good diabetes control, are taking the appropriate doses of folic acid and know how to access the care that they need. At my diabetes preconception clinic, I met a woman with diabetes who had suffered a miscarriage a year ago because she did not realise that she was at high risk and therefore was not supported to manage her condition appropriately. She attended my clinic six months before she wanted to conceive her second baby and we worked together to get her glucose under control, adjust her diet and make changes in her insulin intake. The same woman now has a healthy two year old toddler.”
Jackie Webb, Diabetes Specialist Nurse and Guideline Development Group member: “We know that women with diabetes in pregnancy are at a higher risk of complications such as miscarriage and pre-eclampsia but with the right care these risks can be minimised. The NICE guideline formalises care and sets out the level of information that needs to be provided by healthcare professionals to give women the best chance of having a healthy pregnancy, for example advice about increasing exercise. By bringing together everything we know on the best care of women with diabetes, doctors and midwives will be best placed to offer women the very highest standard of care that they deserve. As a diabetes nurse in an area with high prevalence of the condition, I know that my colleagues will really welcome this guideline.”
Saiyyidah Zaidi, Patient Representative and Guideline Development Group member says: “I was shocked when I found out at 26 weeks that I had gestational diabetes. All of a sudden I had to take in information about a condition that I knew nothing about and suddenly my pregnancy was not about my baby, it was about me. If the NICE guideline had existed when I was going through my first pregnancy, I would have realised that my family origin and weight put me at high risk of getting gestational diabetes and planned accordingly. This guideline takes the information-seeking and questioning that I had to do by myself and puts it into a package to give women the right level of support to help them plan before, during and after their pregnancy. By having good quality information at hand, women have the best chance of a safe and healthy pregnancy.”
Notes to Editors
1.The guidance is available at www.nice.org.uk/CG63
2.Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes, and diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (such as hypoglycaemia) are more common in babies born to women with pre-existing diabetes.
3.Blood glucose levels: measurements (in mmol/l) of the amount of glucose (sugar) in the blood. Glucose in the blood comes from the digestion of starchy foods such as bread, rice, potatoes, chapatis, yams and plantain, from sugar and other sweet foods, and from the liver which makes glucose.
4.Folic acid: or vitamin B9, is very important for the development of a healthy fetus. It reduces the risk of neural tube defects.
5.Gestational diabetes: a type of diabetes that develops during pregnancy because the body cannot produce enough insulin to meet the extra needs of pregnancy.
6.Type 1 diabetes: develops if the body’s pancreas is unable to produce any insulin at all.
7.Type 2 diabetes: develops when the body can still make some insulin, but not enough for its needs, or when the insulin that is produced does not work properly (known as insulin resistance).
About NICE
8.The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
9.NICE produces guidance in three areas of health:
•public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
•health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
•clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
The guideline recommends that women with pre-existing diabetes should access specialist services prior to conception and be given advice on the importance of planning their pregnancy. The guideline also highlights the importance of providing information to women on staying healthy during pregnancy such as by maintaining proper glycaemic control and taking folic acid. This will help to minimise the risks of problems for women with diabetes so that they have the best chance of a good outcome for themselves and their babies.
Key recommendations from the guideline include:
•Women with diabetes who are planning to become pregnant should be informed that establishing good glycaemic control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, of the baby having a malformation at birth, stillbirth and neonatal death.
•Women with diabetes who are planning to become pregnant should be offered pre-conception care and advice before discontinuing contraception.
•If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/l and 1-hour postprandial blood glucose below 7.8 mmol/l during pregnancy.
•Women with diabetes should be offered antenatal examination of the four-chamber view of the fetal heart and outflow tracts at 18–20 weeks.
•
Babies of women with diabetes should be kept with their mothers immediately after birth unless there is a clinical complication or there are abnormal clinical signs that warrant admission for intensive or special care.
•Women who were diagnosed with gestational diabetes should be offered lifestyle advice (including weight control, diet and exercise) and offered a fasting plasma glucose measurement (but not an oral glucose tolerance test) at the 6-week postnatal check and annually thereafter.
Dr Gillian Leng, Deputy Chief Executive, and Executive Lead for this guidance says: “Having a baby is a huge decision for anyone but if you are a woman who has diabetes, it is a decision that requires much more thought and careful planning. We have used the best available evidence from around the world to set a national standard on how midwives and doctors can help women with pre-existing diabetes and gestational diabetes. This guideline will impact on thousands of women and their families and will allow them to prepare adequately so that they have the best possible experience of pregnancy and birth.”
Dr Richard Holt, Diabetes Physician and Guideline Development Group member: “For women with diabetes, planning is the key to having a successful pregnancy so that when they become pregnant they have good diabetes control, are taking the appropriate doses of folic acid and know how to access the care that they need. At my diabetes preconception clinic, I met a woman with diabetes who had suffered a miscarriage a year ago because she did not realise that she was at high risk and therefore was not supported to manage her condition appropriately. She attended my clinic six months before she wanted to conceive her second baby and we worked together to get her glucose under control, adjust her diet and make changes in her insulin intake. The same woman now has a healthy two year old toddler.”
Jackie Webb, Diabetes Specialist Nurse and Guideline Development Group member: “We know that women with diabetes in pregnancy are at a higher risk of complications such as miscarriage and pre-eclampsia but with the right care these risks can be minimised. The NICE guideline formalises care and sets out the level of information that needs to be provided by healthcare professionals to give women the best chance of having a healthy pregnancy, for example advice about increasing exercise. By bringing together everything we know on the best care of women with diabetes, doctors and midwives will be best placed to offer women the very highest standard of care that they deserve. As a diabetes nurse in an area with high prevalence of the condition, I know that my colleagues will really welcome this guideline.”
Saiyyidah Zaidi, Patient Representative and Guideline Development Group member says: “I was shocked when I found out at 26 weeks that I had gestational diabetes. All of a sudden I had to take in information about a condition that I knew nothing about and suddenly my pregnancy was not about my baby, it was about me. If the NICE guideline had existed when I was going through my first pregnancy, I would have realised that my family origin and weight put me at high risk of getting gestational diabetes and planned accordingly. This guideline takes the information-seeking and questioning that I had to do by myself and puts it into a package to give women the right level of support to help them plan before, during and after their pregnancy. By having good quality information at hand, women have the best chance of a safe and healthy pregnancy.”
Notes to Editors
1.The guidance is available at www.nice.org.uk/CG63
2.Miscarriage, pre-eclampsia and preterm labour are more common in women with pre-existing diabetes, and diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (such as hypoglycaemia) are more common in babies born to women with pre-existing diabetes.
3.Blood glucose levels: measurements (in mmol/l) of the amount of glucose (sugar) in the blood. Glucose in the blood comes from the digestion of starchy foods such as bread, rice, potatoes, chapatis, yams and plantain, from sugar and other sweet foods, and from the liver which makes glucose.
4.Folic acid: or vitamin B9, is very important for the development of a healthy fetus. It reduces the risk of neural tube defects.
5.Gestational diabetes: a type of diabetes that develops during pregnancy because the body cannot produce enough insulin to meet the extra needs of pregnancy.
6.Type 1 diabetes: develops if the body’s pancreas is unable to produce any insulin at all.
7.Type 2 diabetes: develops when the body can still make some insulin, but not enough for its needs, or when the insulin that is produced does not work properly (known as insulin resistance).
About NICE
8.The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
9.NICE produces guidance in three areas of health:
•public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
•health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
•clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
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