REMEDY : BNSSG referral pathways

Pregnancy and diabetes

Checked: 10-01-2018 by Rob.Adams Next Review: 10-01-2019

Principals of management

Diabetes in pregnancy is associated with risks to the woman and to the developing fetus. Miscarriage, pre‑eclampsia and preterm labour are more common in women with pre‑existing diabetes. In addition, diabetic retinopathy can worsen rapidly during pregnancy. Stillbirth, congenital malformations, macrosomia, birth injury, perinatal mortality and postnatal adaptation problems (such as hypoglycaemia) are more common in babies born to women with pre‑existing diabetes.

The Diabetes in Pregnancy: management from preconception to the postnatal period guidelines (NICE 2015) give comprehensive advice on management.

Pre- conception

All women with diabetes of childbearing age should be counselled on the importance of optimising treatment of their diabetes.

Pre-conception clinics are available at local trusts and patients who are not already under secondary care follow up can be referred as follows

UHB - Direct referral to the antenatal endocrinology service (they also do pre-conception advice) - not available via e-referral.

NBT - Diabetes - young persons clinic -  via e-referral.

Antenatal

Patients with diabetes who are pregnant require secondary care management and can be referred to the following clinics:

UHB - the antenatal endocrinology service is jointly run by obstetricians and endocrinologists. Referrals should be made directly to the antenatal clinic (not available via e-referral)

NBT - the Southmead Rapid Access Diabetes Clinic will see newly pregnant women with type 1 or type 2 diabetes. Referrals should be made via bleep 9315 or telephone: 07500 027385 or email: diabeticspecialistnurse@nbt.nhs.uk