SIGN Diabetes in Pregnancy
Recommendation
View definitionWomen with T1DM or T2DM planning a pregnancy should aim for an HbA1c as low as possible without excessive hypoglycaemia.
Recommendation
View definitionIn pregnant women with pre-existing diabetes, glucose levels closer to those in people without diabetes should be encouraged as this may reduce the risk of LGA infants and the need for emergency Caesarean sections. Levels should be individualised and balanced with risk of hypoglycaemia.
Recommendation
View definition· For pregnant women with T1DM or T2DM the glucose targets for women with gestational diabetes provide general guidance.
· CGM should be used to assess overall glycaemic levels and women should aim to spend at least 70% time in range (3.5–7.8 mmol/L).
Recommendation
View definitionAdvise pregnant women with T1DM or T2DM and no other complications to have an elective birth by induction of labour, or by elective Caesarean section if indicated, between 37+0 weeks and 38+6 weeks of pregnancy.
Recommendation
View definitionThe diagnosis of GDM is made using a single-step 75 g OGTT when one or more of the following results are recorded in those with risk factors during routine testing:
· fasting plasma glucose ≥5.3 mmol/L
· (one-hour post 75 g oral glucose load ≥10.6 mmol/L, where used)
· two-hour post 75 g oral glucose load ≥9.0 mmol/L.
Recommendation
View definitionHbA1c in early pregnancy (first trimester) should be considered to detect overt diabetes in pregnancy and to identify a cohort at risk of GDM.
· Women with HbA1c ≥48 mmol/mol should be diagnosed with overt diabetes and managed as such.
· Women with HbA1c 42–47 mmol/mol are at high risk of GDM. Glucose monitoring and dietary management is recommended from the second trimester.