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Diabetes in pregnancy

Diabetes in pregnancy. Implementing NICE guidance. 2 nd edition – March 2012. NICE clinical guideline 63. Guideline review . Guideline issue date: 2008 First review : 2011 2011 review recommendation The guideline should be updated.

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Diabetes in pregnancy

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  1. Diabetes in pregnancy Implementing NICE guidance 2nd edition – March 2012 NICE clinical guideline 63

  2. Guideline review • Guideline issue date: 2008 • First review : 2011 • 2011 review recommendation • The guideline should be updated. • The consultation on the scope will take place in March/April 2012. The publication date for the updated guideline has not been confirmed.

  3. What this presentation covers • Background • Risks of diabetes in pregnancy • Key priorities for implementation • Costs and savings • Discussion • NHS Evidence and NICE Pathway • Find out more

  4. Background: prevalence

  5. Risks of diabetes in pregnancy

  6. Key priorities for implementation • Pre-conception care • Antenatal care • Neonatal care • Postnatal care

  7. Pre-conception care: 1 • Inform women with diabetes who are planning to become pregnant that establishing good glycaemic control before conception and continuing this throughout pregnancy will reduce the risk of miscarriage, congenital malformation, stillbirth and neonatal death. • It is important to explain that risks can be reduced but not eliminated.

  8. Pre-conception care: 2 The importance of avoiding unplanned pregnancy should be an essential component of diabetes education from adolescence for women with diabetes. Offer pre-conception care and advice to women with diabetes who are planning to become pregnant before discontinuing contraception.

  9. Antenatal care: 1 If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy. Advise women with insulin-treated diabetes of the risks of hypoglycaemia and hypoglycaemia unawareness in pregnancy, particularly in the first trimester.

  10. Antenatal care: 2 • Admit pregnant women who are suspected of having diabetic ketoacidosis immediately for level 2 critical care where they can receive both medical and obstetric care. • Offer women with diabetes antenatal examination of the four-chamber view of the fetal heart and outflow tracts at 18–20 weeks.

  11. Antenatal care: 3 At the booking appointment screen for risk factors associated with gestational diabetes. Offer testing for gestational diabetes if any one risk factor identified.

  12. Neonatal care • Keep babies of women with diabetes with their mothers unless there is a clinical complication

  13. Postnatal care Offer women who were diagnosed with gestational diabetes: • lifestyle advice • a fasting plasma glucose measurement

  14. Costs and savings per 100,000 population This slide also includes costs and savings for implementing the NICE guidance on antenatal care Costs correct at March 2008. Costs not updated for 2nd edition

  15. Discussion • How can we promote pre-conception services to support women with diabetes to plan for pregnancy? • How can we ensure women with risk factors for gestational diabetes are identified? • What more do we need to do to ensure appropriate referrals are made to joint diabetes and antenatal clinics? • What should we be doing to ensure that we are providing annual follow up of lifestyle advice and fasting blood glucose testing to women diagnosed with gestational diabetes?

  16. NICE Pathway • The NICE Diabetes in pregnancy Pathway covers. Click here to go to NICE Pathways website

  17. NHS Evidence To be added- the latest NHS evidence image Visit NHS Evidence for the best available evidence on all aspects of diabetes. Click here to go to the NHS Evidence website

  18. Find out more • Visit www.nice.org.uk/CG63 for: • other guideline formats • costing report and template • audit support • online educational tool

  19. What do you think? • Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? • We value your opinion and are looking for ways to improve our tools. Please complete this short evaluation form. • If you are experiencing problems accessing or using this tool, please email implementation@nice.org.uk To open the links in this slide set right click over the link and choose ‘open link’

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