Inpatient pregnancy guideline updated

Revised guidance on managing diabetes in pregnant women on maternity wards is now available to access.

The Managing diabetes and hyperglycaemia during labour and birth guideline has been reviewed and amended by the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) to improve pregnancy outcomes for women with type 1, type 2, and gestational diabetes.

The revised recommendations highlight how to safely use insulin during labour and offers consensus target glucose levels for managing diabetes in pregnant women in hospital.

Dr Umesh Dashora, lead author and Consultant Diabetes and Endocrinology, said: “JBDS is pleased to produce an updated guideline to help improve the glucose management of women with diabetes during steroid administration, labour and birth.

“The main difference from the previous guidelines in an option for a slightly more relaxed glucose target of 5.0 to 8.0 mmol/L during labour. Hopefully this will reduce the need to start VRIII with its attendant risks and resource implications in many women with diabetes.”

He continued: “The other main change is to avoid admitting all women with diabetes who are given steroids for VRIII and instead, increasing their SC insulin dose (typically by 50%) and admitting only those who have 2 consecutive readings above the pregnancy targets of 5.0 to 8.0 mmol/L for VRIII. Hopefully these changes will reduce maternal hypoglycaemia and resource burden on labour units.

“JBDS would appreciate if the teams can please audit the impact of these approaches on maternal and neonatal hypoglycaemia which will help when we produce the next version in due course.”

The main recommendations in the report include:

• Every woman with diabetes should have their blood glucose monitored hourly during labour or from the morning of elective caesarean section.
• Aim to sustain glucose levels during labour in the target range advocated in the NICE guidelines or in the range of 5.0 – 8.0 mmol/L due to lack of RCT evidence for either target.
• Women who are on insulin pump therapy or automated insulin delivery systems can decide to remain on insulin pump therapy or automated closed-loop systems after steroids and during the intrapartum and post-natal stages.
• After delivering the placenta, glucose lowering medications in women with gestational diabetes should be halted, but capillary glucose monitoring should continue for up to 24 hours to exclude diabetes.

The authors advised for healthcare professionals to complete the free e-learning module on insulin treatmentfrom Trend Diabetes.

Additionally, they suggested that midwives caring for pregnant women with diabetes should complete the e-learning module from the Royal College of Midwives.

Access the updated guideline here.

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