Quality statement 4: Postnatal testing and referral | Diabetes in pregnancy | Quality standards

Quality statement

Women diagnosed with gestational diabetes are offered postnatal testing of blood glucose levels and referred to the National Diabetes Prevention Programme if eligible. [new 2023]

Rationale

Postnatal blood glucose testing can identify if women have previously undiagnosed type 1 or type 2 diabetes. If women are identified as having diabetes, they will be able to begin treatment. If they do not have diabetes, they can be referred to the National Diabetes Prevention Programme, because women who have gestational diabetes are at significant risk of developing type 2 diabetes.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of women who were diagnosed with gestational diabetes who had a blood test to exclude persisting hyperglycaemia after the birth, before they were transferred to community care.

Numerator – the number in the denominator who had a blood test to exclude persisting hyperglycaemia after the birth, before they were transferred to community care.

Denominator – the number of women who were diagnosed with gestational diabetes.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Proportion of women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after the birth who had a fasting plasma glucose test at 6 to 13 weeks after the birth.

Numerator – the number in the denominator who had a fasting plasma glucose test 6 to 13 weeks after the birth.

Denominator – the number of women who were diagnosed with gestational diabetes whose blood glucose levels returned to normal after the birth.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. For practical reasons, this test might take place at the 6- to 8‑week GP postnatal check.

c) Proportion of women with gestational diabetes who gave birth in the previous 12 months and whose blood glucose levels returned to normal after the birth who were referred into the National Diabetes Prevention Programme.

Numerator – the number in the denominator who were referred into the National Diabetes Prevention Programme.

Denominator – the number of women who had gestational diabetes who gave birth in the previous 12 months and whose blood glucose levels returned to normal after the birth.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records and referrals.

Outcome

a) Early identification of pre-existing type 1 diabetes in women who were diagnosed with gestational diabetes.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

b) Rates of type 2 diabetes in women diagnosed with gestational diabetes.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as GP practices and community and secondary care diabetes services) ensure that systems and pathways are in place for women diagnosed with gestational diabetes to have a blood glucose test to exclude persisting hyperglycaemia after the birth, before they are transferred to community care. For women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after the birth, they should have systems in place to ensure women have:

a fasting plasma glucose test 6 to 13 weeks after the birth to exclude diabetes
a fasting plasma glucose test after 13 weeks if this has not been done earlier, or an HbA1c test if a fasting plasma glucose test is not possible
a referral into the National Diabetes Prevention Programme.

Healthcare professionals (such as GPs, practice nurses, midwives and diabetes nurse specialists) offer women diagnosed with gestational diabetes a blood glucose test to exclude persisting hyperglycaemia after the birth, before they are transferred to community care. For women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after the birth, they should also offer:

a fasting plasma glucose test 6 to 13 weeks after the birth to exclude diabetes
a fasting plasma glucose test after 13 weeks if this has not been done earlier, or an HbA1c test if a fasting plasma glucose test is not possible
a referral into the National Diabetes Prevention Programme.

Commissioners (integrated care systems) ensure that they commission services in which women diagnosed with gestational diabetes have postnatal testing to exclude the possibility of pre-existing type 1 or type 2 diabetes. They also ensure the services refer women diagnosed with gestational diabetes whose blood glucose levels returned to normal after the birth to the National Diabetes Prevention Programme.

Women diagnosed with gestational diabetes are offered a test of their blood glucose to check whether they have persisting hyperglycaemia (high glucose levels) after they have given birth, before they are transferred to community care. If they do, they will receive treatment for this. If they do not, they are offered another test of their blood glucose 6 to 13 weeks after their baby is born to check again whether they have type 1 or type 2 diabetes. If they do not have this test by 13 weeks following their baby's birth, they are offered testing afterwards. They are also offered referral to the National Diabetes Prevention Programme to help to reduce their risk of developing type 2 diabetes.

Source guidance

Diabetes in pregnancy: management from preconception to the postnatal period. NICE guideline NG3 (2015, updated 2020), recommendations 1.6.8 and 1.6.11