Quick guide to antenatal care for women with pre-existing type 1 or type 2 diabetes

Key messages

• Women with pre-existing diabetes who are contemplating pregnancy should be educated on the possible teratogenic effect of diabetes on pregnancy and on the need for tight glycaemic control prior to conception.
• The risk of hypoglycaemia and hypoglycaemic unawareness in pregnancy should be explained to all women on insulin treatment.
• Confirm pregnancy as early as possible and ideally, commence care with a multi-disciplinary team that includes a consultant endocrinologist or a physician experienced in diabetes care in pregnancy, consultant obstetrician, diabetes nurse/midwife specialist and senior dietitian in a dedicated combined Obstetric-Endocrine clinic.
• Visits will usually occur every 2-3 weeks, with variations depending on stage of pregnancy and glycaemic control.
• Measure blood pressure, body weight and urinalysis at each visit as the risk of hypertensive disorders increases when pregnancy is complicated by diabetes.
• Severe, unexplained or frequent episodes of hypoglycaemia can occur as a result of many factors which include; defective counter-regulation, hypoglycaemia unawareness, as well as administration errors in insulin dose, dietary intake or physical activity expenditure.
• For women with type 2 diabetes, non teratogenic oral hypoglycaemic agents may be continued until insulin is commenced to avoid hyperglycaemia which is a known teratogen.
• Women admitted with diabetic ketoacidosis (DKA) should be managed in a high dependency area of care.
• Women with Type 2 diabetes admitted with Hyperosmolar Non-Ketotic Syndrome (HONK) should be managed in a high dependency area of care.
• Delivery should take place in a hospital with full obstetric, anaesthetic and neonatal intensive care facilities and with an experienced paediatrician available for delivery.
• Neonates should be nursed at the mother’s bedside unless admission to intensive care is necessary.
• Early blood glucose testing in the well baby at term should be avoided.