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Reducing diabetes-related complications in pregnancy

02 December 2015
10 min read
Volume 23 · Issue 12

Abstract

Women with pre-existing type 1 and 2 diabetes have an increased risk of adverse pregnancy outcomes, including miscarriage, fetal congenital anomaly and perinatal death. There is a further group of women who develop diabetes during pregnancy, who are also at increased risk of adverse pregnancy outcomes. Since the original publication of the National Institute for Health and Care Excellence (NICE) guidance on diabetes in pregnancy in 2008, there have been several developments that prompted an update. Recently published guidance from NICE (2015) has reviewed studies on the diagnosis and treatment of gestational diabetes and those with pre-existing type 1 and 2 diabetes. This article outlines the background to diabetes, preconception care and the management and prevention of complications throughout pregnancy.

In February 2015, the National Institute for Health and Care Excellence (NICE, 2015) revised its ‘Diabetes in pregnancy’ guideline to include new recommendations based on evidence from recent clinical studies. This article will discuss aspects of the new guidance and its supporting evidence. In 2014, there were 695 233 live births in England and Wales (Office for National Statistics, 2015). It is estimated that up to 5% of all pregnancies are complicated with either pre-existing diabetes or gestational diabetes mellitus (GDM) (Confidential Enquiry into Maternal and Child Health (CEMACH), 2005), therefore affecting approximately 34 000 women per year.

Diabetes is one of the most common complications of pregnancy and encompasses both GDM diagnosed during pregnancy, pre-existing type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) and other rare specific types of diabetes (American Diabetes Association, 2010).

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