Presentation on theme: "Diabetes in pregnancy Implementing NICE guidance 2 nd edition – March 2012 NICE clinical guideline 63."— Presentation transcript:
Diabetes in pregnancy Implementing NICE guidance 2 nd edition – March 2012 NICE clinical guideline 63
Guideline review Guideline issue date: 2008 First review : review recommendation The guideline should be updated. The consultation on the scope will take place in March/April The publication date for the updated guideline has not been confirmed.
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
Background: prevalence Prevalence Number of pregnancies in England Total singleton pregnancies 600,200 Type 1 diabetes0.3% 1,800 Type 2 diabetes0.2% 1,200 Gestational diabetes3.5% 20,400 Total diabetes in pregnancy 23,400
Risks of diabetes in pregnancy Pre-existing diabetesGestational miscarriageneonatal hypoglycaemia congenital malformationperinatal death stillbirth neonatal death fetal macrosomia birth trauma (to mother and baby) induction of labour or caesarean section transient neonatal morbidity obesity and/or diabetes developing later in the babys life
Key priorities for implementation Pre-conception care Antenatal care Neonatal care Postnatal care
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. Pre-conception care: 1
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. Pre-conception care: 2
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. Antenatal care: 1
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. Antenatal care: 2
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.
Neonatal care Keep babies of women with diabetes with their mothers unless there is a clinical complication Admit the baby to a neonatal unit if he or she: is hypoglycemic with abnormal signs has respiratory distress or jaundice that requires monitoring or treatment has signs of cardiac decompensation, neonatal encephalopathy or polycythaemia needs intravenous fluids or tube feeding (unless adequate support is available on the postnatal ward) is born before 34 weeks (or between 34 and 36 weeks if dictated clinically).
Offer women who were diagnosed with gestational diabetes: lifestyle advice a fasting plasma glucose measurement Postnatal care
Costs and savings per 100,000 population Recommendations with significant resource impact (costs/savings ) Costs/savings (£ in first year) Screening for fetal anomalies12,700 Screening for Downs syndrome6500 Screening and testing for gestational diabetes2900 Treatment of gestational diabetes1500 Avoidance of neonatal care for babies of women with diabetes– 2300 Estimated net cost of implementation21,300 This slide also includes costs and savings for implementing the NICE guidance on antenatal care Costs correct at March Costs not updated for 2 nd edition
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?
NICE Pathway The NICE Diabetes in pregnancy Pathway covers. Click here to go to NICE Pathways website
NHS Evidence Visit NHS Evidence for the best available evidence on all aspects of diabetes. Click here to go to the NHS Evidence website To be added- the latest NHS evidence image
Find out more Visit for:www.nice.org.uk/CG63 other guideline formats costing report and template audit support online educational tool
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