First NICE guidance on diabetes in pregnancy

NICE has emphasised the importance of establishing good glycaemic control in draft guidance on diabetes in pregnancy.

It recommends that GPs inform diabetic women who are planning to become pregnant about the importance of glycaemic control before conception and throughout pregnancy. Good glycaemic control can reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death, NICE adds.

Women should use contraception until good glycaemic control is established, the guidance says. During pregnancy, women with diabetes should keep fasting blood glucose between 3.5 and 5.9mmol/l and one-hour postprandial blood glucose below 7.8mmol/l.

Women with type-1 diabetes who are suspected of having diabetic ketoacidosis should be admitted immediately to a high- dependency unit to receive both medical and obstetrical care.

After birth, women with gesta-tional diabetes, which accounts for 65 per cent of pregnancies involving diabetic women, should be offered advice on weight control, diet and exercise.

The guidance calls for the women to be offered a fasting plasma glucose measurement at the six-week postnatal check and annually thereafter.

Warwickshire GP Dr Roger Gadsby, who helped develop the NICE guidance, said: 'This is the first guidance on managing diabetes in pregnancy and is based on robust evidence. It provides GPs with comprehensive guidance right the way through pregnancy from preconception to care after pregnancy.'

It is important for GPs to rein-force the importance of good glycaemic control at the time of conception, said Dr Gadsby.

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