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Pregnancy and diabetes

Checked: 27-11-2023 by Vicky Ryan Next Review: 27-11-2025

Overview

Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre‑eclampsia and preterm labour are more common in women with pre‑existing diabetes. In addition, 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.

NICE Guideline (NG3)

Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE - gives comprehensive advice on management (1).

Pre-conception

All women with diabetes of childbearing age should be counselled on the importance of optimising treatment of their diabetes.

Pre-conception planning and care| Guidance | NICE

Patient information

Planning for a pregnancy when you have diabetes | Diabetes UK

Referral

NBT - Diabetes pre-pregnancy clinic via eRS - include results of HbA1c, lipid profile (total, HDL & LDL cholesterol, triglyceride), U&Es, urinary ACR, LFTs & thyroid function in last year.
UHBW - Diabetic Medicine clinic via email (ObstetricMedicalSecretaries@uhbw.nhs.uk) - include results of HbA1c, lipid profile, (cholesterol, TG, LDL, HDL) and creatinine (in last 3 months).

Gestational Diabetes

Gestational Diabetes - Risk assessment, testing and diagnosis | Guidance | NICE

Risk Factors

Risk of gestational diabetes in a healthy population include:

BMI above 30 kg/m²
Previous macrosomic baby weighing 4.5 kg or more.
Previous gestational diabetes
Family history of diabetes (first‑degree relative with diabetes)
Ethnicity with a high prevalence of diabetes.

Testing

Do not use fasting or random plasma glucose, HbA1c, or urinalysis to assess the risk of developing gestational diabetes.

An oral glucose tolerance test should be performed if there are risk factors or gestational diabetes is suspected (see NG3 for advice on glycosuria and dianostic thresholds)..

Referral

Refer as below if gestational diabetes is confirmed.

Referral

Patients with exisiting diabetes who become pregnant or those who develop gestational diabetes should be referred to their local antenatal clinic or diabetes service as appropriate. Referrals can often be done by their community midwife.

UHBW patients - see the Maternity Services page for referral information.
NBT patients - see the Rapid Access Diabetes Clinics page for referral information.

Resources

(1) Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

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