References

Brigham and Women’s Hospital. Pregnancy and Diabetes. 2022. https://www.brighamandwomens.org/obgyn/maternal-fetal-medicine/pregnancy-and-medical-conditions/diabetes (Accessed 16th January 2023)

Broughton C., Douek I. ‘An overview of the management of diabetes from pre-conception, during pregnancy and in the postnatal period’. Clinical Medicine Journal. 2019; 19:(5)399-402 https://doi.org/10.7861/clinmed.2018-0288

Centers for Disease Control and Prevention. Type 1 and Type 2. 2022. https://www.cdc.gov/pregnancy/diabetes-types.html (Accessed 16th January 2023)

Type 1 Diabetes. 2023. https://medlineplus.gov/ency/article/000305.htm (Accessed 13th November 2023)

Diabetes UK. What Is DKA. Diabetic Ketoacidosis?. 2024a. https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_ketoacidosis (Accessed 4th May 2024)

Diabetes UK. NICE announces final appraisal recommendations on hybrid closed-loop systems for type 1 diabetes. 2024b. https://www.diabetes.org.uk/about-us/news-and-views/hybrid-closed-loop-technology-recommended-thousands-type-1 (Accessed 4th May 2024)

Diabetes UK. Getting a free CGM, flash glucose monitor. freestyle libre. or insulin pump on the NHS - who should qualify?. 2024c. https://www.diabetes.org.uk/guide-to-diabetes/diabetes-technology/cgm-flash-pump-who-qualifies-on-nhs (Accessed 4th May 2024)

Faculty of Sexual and Reproductive Healthcare. Standards and guidance. 2022. https://www.fsrh.org/standards-and-guidance/search/?order=newest (Accessed 16th January 2023)

GP Notebook. Referral criteria from primary care - kidney disease. 2022. https://gpnotebook.com/en-GB/pages/renal-medicine/referral-criteria-from-primary-care-kidney-disease (Accessed 13th November 2023)

Guys and St Thomas’ NHS Foundation Trust. Planning a healthy pregnancy. 2022. https://www.guysandstthomas.nhs.uk/health-information/diabetes-and-pregnancy/planning-healthy-pregnancy (Accessed 16th January 2023)

Can you have a safe pregnancy if you have Type 2 DiabetesT2DM?. 2018. https://www.healthline.com/health/pregnancy/type-2-diabetes (Accessed 16th January 2023)

Juvenile Diabetes Research Foundation. Pregnancy. 2022. https://jdrf.org.uk/information-support/living-with-type-1-diabetes/health-and-wellness/pregnancy/ (Accessed 16th January 2023)

Kalra B., Gupta Y., Singla R., Kalra S. ‘Use of Oral Anti-Diabetic Agents in Pregnancy: A Pragmatic Approach’. North American Journal of Medical Sciences. 2015; 7:(1)6-12 https://doi.org/10.4103/1947-2714.150081

Know Diabetes. Planning a pregnancy when you have diabetes. 2022. https://www.knowdiabetes.org.uk/resources/internal/planning-a-pregnancy-when-you-have-diabetes/ (Accessed 16th January 2023)

Lab Tests Online UK. HbA1c. 2021. https://labtestsonline.org.uk/tests/hba1c-test (Accessed 13th November 2023)

Lab Tests Online UK. Urine Albumin to Creatinine Ratio or ACR. 2022. https://labtestsonline.org.uk/tests/urine-albumin-creatinine-ratio-or-acr (Accessed 13th November 2023)

Lassi Z., Imam A., Dean S., Bhutta Z. ‘Preconception care: screening and management of chronic disease and promoting psychological health’. Reproductive Health. 2014; 11 https://doi.org/10.1186/1742-4755-11-S3-S5

Medicines and Healthcare products Regulatory Agency. ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy. 2014. https://www.gov.uk/drug-safety-update/ace-inhibitors-and-angiotensin-ii-receptor-antagonists-not-for-use-in-pregnancy (Accessed 13th November 2023)

Milton Keynes University Hospital NHS Foundation Trust. Blood Ketones Testing. 2024. https://www.mkuh.nhs.uk/patient-information-leaflet/blood-ketone-testing (Accessed 4th May 2024)

Mortagy I., Kielmann K., Baldeweg S., Modder J., Pierce M. ‘Integrating preconception care for women with diabetes into primary care: qualitive study’. British Journal of General Practice. 2010; 60:(580)815-821 https://doi.org/10.3399%2Fbjgp10X532594

National Diabetes Service Scheme. Planning for pregnancy, for women with type 1 diabetes. 2023. https://www.ndss.com.au/about-diabetes/pregnancy/type-1-diabetes/planning-for-pregnancy/ (Accessed 16th January 2023)

National Health Service. Diabetes and pregnancy. 2021. https://www.nhs.uk/pregnancy/related-conditions/existing-health-conditions/diabetes/ (Accessed 16th January 2023)

National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. 2020. https://www.nice.org.uk/guidance/ng3/chapter/recommendations#continuous-glucose-monitoring (Accessed 16th January 2023)

National Institute for Health and Care Excellence. Insulin therapy in type 2 diabetesT2DM. 2021. https://cks.nice.org.uk/topics/insulin-therapy-in-type-2-diabetes/ (Accessed 16th January 2023)

National Institute for Health and Care Excellence. Diabetes - type 1. 2022. https://cks.nice.org.uk/topics/diabetes-type-1/ (Accessed 16th January 2023)

National Institute of Diabetes and Digestive and Kidney Diseases. Pregnancy if you have Diabetes. 2017. https://www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy (Accessed 16th January 2023)

NHS England. NHS helps thousands of pregnant smokers kick the habit. 2022. https://www.england.nhs.uk/2022/07/nhs-helps-thousands-of-pregnant-smokers-kick-the-habit/ (Accessed 4th May 2024)

North Bristol NHS Trust. Pregnancy and Type 2 Diabetes T2DM. 2021. https://www.nbt.nhs.uk/maternity-services/pregnancy/diabetes-pregnancy/pregnancy-type-2-diabetes (Accessed 16th January 2023)

Nursing and Midwifery Council. Read the Code online. 2018. https://www.nmc.org.uk/standards/code/read-the-code-online/ (Accessed 16th January 2023)

Nwolise C., Carey N., Shawe J. ‘Preconception Care Education for Women with Diabetes: A Systematic Review of Conventional and Digital Health Interventions’. Journal of Medical Internet Research. 2016; 18:(11) https://doi.org/10.2196/jmir.5615

Temple R. ‘Preconception care for women with diabetes: is it effective and who should provide it?’. Best Practice & Research Clinical Obstetrics & Gynaecology. 2011; 25:(1)3-14 https://doi.org/10.1016/j.bpobgyn.2010.10.001

The London Diabetes Centre. Pregnancy care for type 1 diabetics. 2021. https://londondiabetes.com/type-1/pregnancy/ (Accessed 16th January 2023)

Tommy’s. Planning for Pregnancy. 2022. https://www.tommys.org/pregnancy-information/planning-pregnancy/planning-for-pregnancy-tool (Accessed 16th January 2023)

UNICEF Parenting. What to avoid when pregnant. 2024. https://www.unicef.org/parenting/child-development/what-avoid-when-pregnant (Accessed 4th May 2024)

World Health Organization. Diabetes. 2023. https://www.who.int/health-topics/diabetes#tab=tab_1 (Accessed 16th January 2023)

Yale Medicine. Hypertension. High Blood Pressure. During Pregnancy. 2024. https://www.yalemedicine.org/conditions/hypertension-high-blood-pressure-during-pregnancy (Accessed 4th May 2024)

Yehuda I. ‘Implementation of Preconception Care for Women with Diabetes’. Diabetes Spectrum. 2016; 29:(2)105-114 https://doi.org/10.2337/diaspect.29.2.105

Diabetes Mellitus: Preconception management in primary care

02 June 2024
Volume 35 · Issue 6

Abstract

Women with diabetes experience adverse risks to their health and the health of their foetuses during pregnancy. This article draws upon research to help primary care nurses advise and care for patients who fall into this category

Diabetes mellitus is associated with adverse risks to both pregnant women and their foetuses. These risks include; congenital malformations, stillbirth and miscarriage. The infant is also at risk of developing diabetes mellitus and other health issues in the future. This article provides an overview of diabetes mellitus and pregnancy. Addressing the importance of preconception management and the role general practice nurses have in increasing favourable outcomes, through improving preconception management in primary care. Discussing integrating primary and secondary care to enable continuity of care. Analysing the research on the impact health care professionals conducting educational interventions has on patient's pregnancy outcomes. As well as the use of conventional and digital methods to provide health education on preconception care.

Diabetes Mellitus is a metabolic and chronic disease, which is identified by elevated blood glucose levels. These elevated blood glucose levels can result in developing macrovascular and microvascular complications (World Health Organization, 2023). The two main types of diabetes mellitus are type 1 and type 2, the most prevalent type is Type 2 Diabetes Mellitus (hereafter referred to as T2DM) (World Health Organization, 2023). Without insulin replacement in Type 1 Diabetes Mellitus (T1DM), death will occur within weeks or days (National Institute for Health and Care Excellence, 2022).

The National Institute for Health and Care Excellence (NICE) provides guidelines for managing preconception and diabetes mellitus. Under these guidelines, NICE advises providing women with diabetes mellitus with the requisite information, support and advice to mitigate the adverse risks to mother and foetus that are associated with diabetes mellitus and pregnancy (National Institute for Health and Care Excellence, 2020). These risks include; miscarriage, stillbirth, perinatal death, congenital malformations, neural tube defect, neonatal hypoglycaemia, blood glucose control affected by nausea and vomiting (National Institute for Health and Care Excellence, 2020). The infant may also be large for their gestational age, resulting in labour inductions, birth traumas, shoulder dystocia, caesarean section and instrumental deliveries (National Institute for Health and Care Excellence, 2020). Monitoring through an early ultrasound scan at approximately 7 weeks gestation is crucial (Guy's and St Thomas NHS Foundation Trust, 2022). The infant is also at risk of developing diabetes mellitus in the future (National Institute for Health and Care Excellence, 2020).

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