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Summary of Results

Health Topic:   Gynaecology, pregnancy and birth
Guidance:   Diabetes in pregnancy
Description:   The summary of the published clinical guideline on Diabetes in pregnancy . It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage

External literature

External literature Assessment Coverage

Wilson N et al (2009) The Multidisciplinary Diabetes-endocrinology Clinic and Postprandial Blood Glucose Monitoring in the Management of Gestational Diabetes: Impact on Maternal and Neonatal Outcomes Experimental Clinical Endocrinol Diabetes 2009 117(9): 486-489

Description: This article describes the result of an audit comparing the maternal and foetal outcomes for 2 cohorts of patients with GDM treated in the UHCW Trust in 2000-2 and 2006-8. Between 2000-2 and 2006-08 there was a significant reduction in mean maternal glycosylated haemoglobin (HbA1c) in trimester 3 of pregnancy. Evidence suggests that introduction of the measures recommended in NICE guidance can effect significant improvement in maternal glycaemic control and foetal outcomes.

Not graded Local

Meti S et al (2009) Pre-conceptional diabetes in pregnancy: Evaluation of current clinical practice in a District General Hospital in England International Journal of Gynaecology and Obstetrics S413-S729

Description: A total of 36 patients with pre-exisiting type 1 & type 2 diabetes mellitus were identified retrospectively using the maternity unit admission registers from January 2003 to December 2007. Results found that the still birth rate 1/36 (2.8%) was comparable to national figures. Caesarean section rate (total 61.1% elective was 25% emergency 36.1%) better than the national average.

Practice appears to be in line with guidance Local

CMACE (2010) Maternal obesity in the UK: findings from a national project

Description: In 2008, the Confidential Enquiry into Maternal and Child Health (CEMACH), now known as the Centre for Maternal and Child Enquiries (CMACE), commenced a 3-year UK-wide Obesity in Pregnancy project. The project included a national clinical audit of maternity care received by 905 women with a BMI 35.The CMACE audit revealed that 73% of women with a BMI 35 were offered a test for GDM and not all of these had an OGTT performed.

Doubts about or mixed impact in practice National

Pierce M et al (2011) Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England British Journal of General Practice 2011; 61: 609-610

Description: This study examined the reported practice of primary care and secondary care doctors in England at the time of publication of NICE guidance. Questionnaires were sent out in 2008 and 60% of GPs and 93% of specialists responded. Results showed that there was variation in the type of tests that GPs requested: 55% requested fasting plasma glucose and 31% requested oral glucose tolerance tests. 98% of specialists said that women should have checks for ongoing diabetes postpartum.

Doubts about or mixed impact in practice National

Churchill. D et al (2011) Improving uptake of postnatal test with fasting glucose Diabetic medicine, 28 (Suppl. 1), pp 173. Diabetes UK Annual Professional Conference 2011. Professional conference proceedings.

Description: This study aimed to compare the uptake of oral glucose tolerance tests (OGTT) and fasting blood glucose (FBG) tests during post natal follow up. 90 women with gestational diabetes (GDM) who delivered in 2006 were offered OGTT, of which 74% attended the test. After implementation of NICE guidance in 2009, 110 women who had GDM were offered FBG estimation, 96% attended. Results found that in women with GDM, FBG estimation had a higher uptake than OGTT for postnatal assessment of hypoglycaemia.

Practice appears to be in line with guidance Local

Lee, R. et al (2013) An audit of screening for gestational diabetes mellitus BJOG: An International Journal of Obstetrics and Gynaecology. 2013 Conference (var.pagings) PAGES June -

Description: This retrospective audit, conducted October - December 2012, measured current screening practice for gestational diabetes at University Hospital Wales, Cardiff. Results from questionnaires completed by 96 women found that 66.6% of women with at least one risk factor were given an oral glucose tolerance test, 3% of which were positive.

Doubts about or mixed impact in practice Local

Oo, T. et al (2013) The management and the outcome of gestational diabetic women in North tees and Hartlepool NHS trust, United Kingdom: Departmental Audit 2012 BJOG: An International Journal of Obstetrics and Gynaecology. 2013 Conference (var.pagings) PAGES June -

Description: This study aimed to investigate the management and the outcome of gestational diabetes at North Tees and Hartlepool NHS Trust. Retrospective review of 52 patients between July 2010 and May 2011 found screening for diabetes was performed as per guidance but cut off level for BMI >35 was used instead of 30. All patients received health education and 75% were seen by a dietician.

Practice appears not to be in line with guidance Local

This page was last updated: 01 June 2013

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.