Management of diabetes from preconception to the postnatal period: summary of NICE guidance

doi:10.1136/bmj.39505.641273.AD

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The Guideline Development Group

Moira A Mugglestone, National Collaborating Centre for Women’s and Children’s Health, London W1T 2QAmmugglestone{at}ncc-wch.org.uk

Why read this summary?

Diabetes in pregnancy is associated with risks to the woman (for example, higher rates of miscarriage, pre-eclampsia, and preterm labour) and to the developing fetus and baby (for example, higher rates of congenital malformations, macrosomia, birth injury, and perinatal mortality).1 2 This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on how to manage diabetes and its complications from preconception to the postnatal period.3

Recommendations

NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the guideline development group’s opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Preconception information for women with pre-existing diabetes

From adolescence onwards, advise women about the importance of avoiding unplanned pregnancy. [Based on a high quality national clinical audit]
Inform women and their families about how diabetes affects pregnancy and how pregnancy affects diabetes (box 1).
Offer preconception care and advice to women who are planning to become pregnant before they discontinue contraception [based on high quality evidence from a meta-analysis of small to medium sized cohort studies and a health economic model]; inform them that establishing good glycaemic control before conception and continuing throughout pregnancy reduces—but does not eliminate—the risks of miscarriage, congenital malformation, stillbirth, and neonatal death [based on high quality evidence from a small non-randomised controlled trial and small to medium sized cohort studies].
Offer a structured education programme (such as “dose adjustment for normal eating” (DAFNE) for type 1 diabetes, “diabetes education and self management for ongoing and newly diagnosed” type 2 diabetes (DESMOND), or X-PERT for type 2 diabetes) as soon as possible to women who are planning to become pregnant (unless they have already attended one).