Revised JBDS pregnancy guideline published
Updated recommendations on how to manage diabetes in pregnant women on maternity wards has been made available.
The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) has published a revised version of the Managing diabetes and hyperglycaemia during labour and birth guideline to improve pregnancy outcomes amongst women with diabetes.
Throughout the updated guidance, there is an emphasis on how to safely use insulin during labour and it provides consensus target glucose levels for managing diabetes in pregnant women in hospital.
Lead author Dr Umesh Dashora, 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 added: “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.”
Some of the report’s key recommendations include:
- All women with diabetes should have hourly blood glucose monitoring in labour or from the morning of elective caesarean section.
- Aim to maintain glucose levels during labour in either 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 may choose to remain on insulin pump therapy or automated closed-loop systems after steroids and during the intrapartum and post-natal periods.
- Glucose lowering medications in women with gestational diabetes should be stopped after delivery of the placenta, but you should continue capillary glucose monitoring for up to 24 hours to exclude diabetes.
The authors have recommended that healthcare professionals should complete Trend Diabetes’ free e-learning module on insulin treatment.
In addition, they have advised that midwives looking after pregnant women with diabetes should consider completing the e-learning module provided by the Royal College of Midwives.
To access the updated guideline, click here.