CPD module: Diabetes in pregnancy - the primary care role

Reena Patel and Dr Sarah N Ali describe the primary care role in management of women with type 1 or type 2 diabetes while they are planning a pregnancy, pregnant and postpartum

The population with diabetes is becoming younger, meaning the incidence of type 2 diabetes among women of child-bearing age is increasing.

This learning module will enable you to understand the role and limitations of practice nurses in preconception, pregnancy and postpartum care of women with diabetes, and gain confidence in advising and supporting women with diabetes in planning a pregnancy.

Pregnancy in women with diabetes – both those with pre-existing diabetes and those with gestational diabetes, where the mother develops high blood sugar during pregnancy, usually in the second or third trimester – is considered high-risk.

This means the pregnancy must be managed in secondary care by joint antenatal clinics led by a consultant obstetrician and consultant diabetologist, with a specialist team consisting of a diabetes specialist nurse, diabetes specialist midwife and a diabetes specialist dietitian, in accordance with the NICE guidelines.

As such, primary care nurses must always refer women with diabetes who are pregnant, or who are planning to get pregnant, to the relevant specialist team for early intervention.

Nonetheless, primary care nurses have an important role in preconception care, in particular in counselling patients about the importance of achieving good glycaemic control prior to conceiving.

They also support with postpartum management, for example to support patients to achieve safe glycaemic targets, ensure appropriate contraception and carry out postnatal checks for diabetes in women who developed gestational diabetes.

Key points

Ensure all women with diabetes of childbearing age are given preconception counselling and contraception advice at all diabetes reviews
Ensure all women with diabetes are advised to plan pregnancy well in advance and aim to achieve glucose targets to reduce pregnancy risks
Identify women with diabetes who wish to fall pregnant and highlight to the GP or local diabetes team
Follow up any missed appointments – for example, annual retinal screening, foot checks and blood tests
Provide diet and lifestyle advice such as smoking cessation, mental wellbeing, exercise, adequate hydration and sleep hygiene
Offer health promotion advice such as for dental hygiene, travel and fasting during pregnancy for religious purposes
Prioritise routine vaccinations in line with national recommendations for pregnant women – for example, flu and whooping cough, as well as Covid vaccination

Upskilling and staying up to date with current evidence-based practice is vital for nurses. There should be a practice protocol which is followed to maintain a good standard of care.