Berkshire West Diabetes Newsletter March 2018

Pregnancy and diabetes

Diabetes is the most common medical complication during pregnancy, affecting about 3.3% of all live births. It requires specialist input and we are fortunate to have an excellent team of consultants and specialist midwives at the RBFT. The following article has been written by Jean Eustace, Diabetes Specialist Midwife.

Antenatal Diabetes Clinic

Diabetes in pregnancy, whether pre-existing diabetes or gestational diabetes, is associated with a small increased risk in adverse pregnancy outcomes, as well as an increased risk of induction of labour, caesarean section and neonatal hypoglycaemia. Good diabetes care during pregnancy is vital to obtaining the best possible outcomes, minimising the risk to both mother and baby.

The antenatal diabetes clinics adopt a multi-disciplinary approach, shown to be the best model for organising antenatal diabetes care.

Referral

Pre-existing diabetes (Type 1, Type 2, Mody)

For those with pre-existing diabetes, women can self-refer to the Diabetes Specialist Midwives (DSM) via 0118 322 7245 (secure, confidential voicemail available) as soon as they have a positive pregnancy test. Alternatively this can be done by their GP or community midwife via the same telephone number. As a minimum, please provide the woman’s name, date of birth and contact details.

Testing and diagnosing gestational diabetes (GDM)

An OGTT (Oral glucose tolerance test) is used to diagnose GDM and the thresholds we use are a fasting result of 5.6mmol/l and a two hour post glucose result of 7.8mmol/l.

If a patient has had GDM in a previous pregnancy, then the community midwife will offer a test in the 2-3 weeks after booking, and again at 24-28 weeks. If the patient has not had GDM before, but has risk factors listed below, then she will be offered a test at 24-28 weeks.

Risk factors for screening:

  • Previous GDM
  • Afro-Caribbean and Asian origin
  • Previous baby with birth weight >4500gm
  • BMI >35kg/m2
  • First degree relative with diabetes
  • Women on anti-psychotics

The OGTT can be booked by calling Maternity Appointments on 0118 322 7295, and the clinic is held in the ANC at the Royal Berkshire Hospital on weekday mornings. Women should be told to fast from 10pm the night before the test and only take sips of water. Results will automatically be received by the DSMs, who will contact all women with positive results.

If a woman develops polyhydramnios, has a fetus larger than the 95th centile on ultrasound, or has +glycosuria on 2 occasions, or ++ glycosuria on one occasion, then please book an OGTT.

Clinic Details

OGTT Clinics take place in the antenatal clinic, Level 2 of the Maternity Block. Every Tuesday and Thursday mornings there is a clinic where those with gestational diabetes will be seen by the diabetes specialist midwives. On Thursday afternoon there is a joint obstetric/diabetes consultant clinic where all patients with Type 1 or Type 2 diabetes will be seen.

Multidisciplinary Specialist Team

Consultant Obstetrician: Miss Sunetra Sengupta
Consultant Diabetologist: Dr Ian Gallen
Consultant Diabetologist: Dr George Farah
Diabetes Specialist Midwives: Louise Critcher and Jean Eustace

Postnatal care

Women with type1 and type 2 diabetes will revert to their pre-pregnancy care, either with their GP or at Melrose House Diabetes Centre. Women with gestational diabetes will need to have a fasting plasma glucose test, prior to their six week postnatal GP check-up.

The diabetes midwives are happy to discuss diabetes care with GPs on 0118 322 7245, or by email at rbft.diabetes-midwife@nhs.net

Guidelines also suggest gestational diabetes patients have a FBG annually thereafter even if the diabetes has resolved.