Women with gestational diabetes should be diagnosed if they have a plasma glucose level on 5.6 mmol / liter (100 mg) or higher, or a level of glucose in plasma 2 hours after the intake of 7.8mmol / liter (140 mg) or higher, according to the new NICE recommendations.
Updated guidelines on diabetes in pregnancy lower plasma glucose thresholds for diagnosis, and include new recommendations on self -management for women with type 1 diabetes.
Around 35,000 women have diabetes, whether pre-existing or gestational, every year in England and Wales.
Almost 90 percent of women who have diabetes during pregnancy, have gestational diabetes, which can or cannot be resolved after pregnancy.The rates have increased in recent years due to the growing rates of obesity among the general population and the increase in number of pregnancies among older women.
Of women with diabetes in pregnancy that do not have gestational diabetes, 7.5 percent have type 1 diabetes, and the rest have type 2 diabetes, which have also recently increased.
Following a series of events, such as new technologies and research on the diagnosis and treatment of gestational diabetes, NICE has updated its guidelines on diabetes in pregnancy.
Diagnosis
Among the new recommendations, it is mentioned that a woman must be diagnosed with gestational diabetes if she has a level of plasma glucose on a fasting of 5.6 mmol / liter (100 mg) or higher, or a plasma glucose level 2 hours 2 hours 2 hoursafter the intake of 7.8 mmol / liter (140 mg) or higher.
NICE recommendations say this could help address the variation in glucose levels used for the diagnosis of gestational diabetes, and can lead to an increase in the number of women with a diagnosis of gestational diabetes.
prenatal and postnatal
NICE recommends that doctors, midwives and other primary care professionals should advise pregnant women with any form of diabetes to maintain their capillary plasma glucose below certain objective levels, if these are attainable without causing problematic hypoglycemia.
The recommended objective levels are 5.3 mmol / liter (100 mg) for fasting, and 7.8 mmol / liter (140 mg) 1 hour after meals, or 6.4 mmol / liter (115 mg) 2 hoursAfter meals.
The recommendations updated also cover women with gestational diabetes whose glucose levels have returned to normal after birth.
NICE says that these women should be offered lifestyle that includes weight control, diet and exercise, and fast plasma glucose test 6-13 weeks after birth to rule out diabetes.
NICE recommends that oral glucose tolerance tests (75 g with control at 2 hours) should not be offered routinely to women who were diagnosed with gestational diabetes whose blood glucose levels returned to normal after birth after birth.
In addition, women who were diagnosed with gestational diabetes who have a negative postnatal test for diabetes should be offered an annual HBA1C test.
NICE recommends that women with type 1 diabetes who are planning to get pregnant should be offered reactive strips for the blood test and a measurement instrument.These women should be warned about cactonemia tests if they are hyperglycemic or feel discomfort.
While the prescription of Cetona test strips and the cost of HBA1C exams can lead to additional costs, NICE says these costsThey could be compensated with potential savings and benefits such as the reduction of complications during pregnancy and childbirth, a reduction in external consultations before diagnosis, and an improvement of attention to the mother and the baby.
