Diabetes in pregnancy: a practical guide for midwives
Diabetes is a growing concern. With the rising incidence of obesity in the younger people, the incidence of diabetes has also increased. This has resulted in more women of childbearing age attending antenatal clinic with a diagnosis of either pre-existing or gestational diabetes. Management of these women is vital to avoid complications in both the mother and the child during pregnancy and childbirth. This article aims to provide a concise guide to the management of diabetes in pregnancy for midwives, who are often the first point of contact for these women.
The incidence of diabetes mellitus is increasing, alongside the increased prevalence of obesity, sedentary lifestyle, older age at conception and younger age at onset of type 2 diabetes, meaning that more women are pregnant and have diabetes (McCance et al, 2011; National Institutes of Health, 2013; Guariguata et al, 2014).
As midwives are often the first point of contact for women during pregnancy, the following article aims to provide a concise, practical review, from the first visit to the postnatal period. The article is aimed at both community and hospital-based midwives and gives an overview of care with relevant supporting evidence.
Wherever possible, the authors recommend referring to local guidelines for specifics of care. Until 2009, glycated haemoglobin (HbA1c) was solely reported in Diabetes Control and Complications Trial units (%). To standardise reporting across the world, the International Federation of Clinical Chemistry units (which report HbA1c as mmol/mol) were introduced and adopted in the UK in 2009. HbA1c is reported in both formats throughout this article. Women who have type 1 or type 2 diabetes before pregnancy are referred to as ‘pre-existing diabetes’, but distinguished where necessary.
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