Quality statement 6: Risk assessment – gestational diabetes

Quality statement

Pregnant women are offered testing for gestational diabetes if they are identified as at risk of gestational diabetes at the booking appointment.

Quality measure

Structure

a) Evidence of local arrangements to ensure that pregnant women have their risk factors for gestational diabetes identified and recorded at the booking appointment.

b) Evidence of local arrangements to ensure that pregnant women identified as at risk of gestational diabetes at the booking appointment are offered testing for gestational diabetes.

Source data: a) and b) Local data collection.

Process

a) Proportion of pregnant women identified as at risk of gestational diabetes at the booking appointment who are offered testing for gestational diabetes.

Numerator – the number of women in the denominator offered testing for gestational diabetes.

Denominator – the number of pregnant women identified as at risk of gestational diabetes at the booking appointment.

b) Proportion of pregnant women identified as at risk of gestational diabetes at the booking appointment who receive testing for gestational diabetes.

Numerator – the number of women in the denominator receiving testing for gestational diabetes.

Denominator – the number of pregnant women identified as at risk of gestational diabetes at the booking appointment.

Data source: a) and b) Local data collection. The NICE guideline CG62 audit support, criterion 8 and 9. The Maternity Services Secondary Uses Dataset, once implemented, will collect data on the following risk factors at booking: maternal height (global number 17209970) and weight (global number 17209960), maternal family history of diabetes (global number 17200950) and ethnic group (global number 17200030), and obstetric diagnoses from previous pregnancies including gestational diabetes mellitus (global number 17200720). The date of the booking appointment will also be available (global number 17201190).

Outcome

Early identification of women with gestational diabetes.

What the quality statement means for each audience

Service providers ensure that systems are in place to offer pregnant women identified as at risk of gestational diabetes at the booking appointment testing for gestational diabetes.

Healthcare professionals offer pregnant women identified as at risk of gestational diabetes at the booking appointment testing for gestational diabetes.

Commissioners ensure they commission services that offer pregnant women identified as at risk of gestational diabetes at the booking appointment testing for gestational diabetes.

Pregnant women with a higher than normal chance of developing gestational diabetes (a type of diabetes that occurs during pregnancy) at the booking appointment are offered a test for gestational diabetes.

Source guidance

Definitions

Risk factors are taken from NICE guideline NG3:

  • body mass index above 30 kg/m2

  • previous macrosomic baby weighing 4.5 kg or above

  • previous gestational diabetes

  • family history of diabetes (first-degree relative with diabetes)

  • minority ethnic family origin with a high prevalence of diabetes.

Women with any 1 of these risk factors should be offered testing for gestational diabetes.

Testing for gestational diabetes should be carried out in accordance with diabetes in pregnancy NICE guideline NG3:

Use the 2-hour 75 g oral glucose tolerance test (OGTT) to test for gestational diabetes in women with risk factors.

Offer women who have had gestational diabetes in a previous pregnancy:

  • early self-monitoring of blood glucose or

  • a 75 g 2-hour OGTT as soon as possible after booking (whether in the first or second trimester), and a further 75 g 2-hour OGTT at 24–28 weeks if the results of the first OGTT are normal.

Offer women with any of the other risk factors for gestational diabetes a 75 g 2-hour OGTT at 24–28 weeks.

Equality and diversity considerations

Any risk assessment for gestational diabetes should be corrected for family origin. Some family origins are risk factors for diabetes (see definitions) and people from these groups should be offered testing in accordance with the guidance.