The Multidisciplinary Diabetes-endocrinology Clinic and Postprandial Blood Glucose Monitoring in the Management of Gestational Diabetes: Impact on Maternal and Neonatal Outcomes

Abstract

Gestational Diabetes Mellitus (GDM) is associated with an increased the risk of maternal and foetal complications in pregnancy. However, these complications can significantly be reduced if GDM is detected early and treated. Recently published NICE guidelines recommended that GDM should be managed in a specialist joint endocrinology-diabetes clinic; dietary/lifestyle advice should be given, 1 h postprandial blood glucose should be monitored, and glycaemic control should be assessed by a diabetic care team. In the University Hospital Coventry and Warwickshire (UHCW) NHS Trust these measures were introduced between 2003 and 2005. This article describes the results of an audit comparing the maternal and foetal outcomes for 2 cohorts of patients with GDM treated in the UHCW Trust in 2000–2 and 2006–8. Between 2000–2 and 2006–8 there was a significant reduction in mean maternal glycosylated haemoglobin (HbA1c) in trimester 3 of pregnancy, mean foetal birth weight and neonatal admission rate to the special care baby unit (SCBU). This evidence suggests that introduction of the measures recommended by NICE can effect significant improvement in maternal glycaemic control and foetal outcomes.

Key words

Gestational Diabetes - multidisciplinary clinic - glucose monitoring - maternal impact - neonatal impact

References

• 1 Metzger BE, Coustan DR. , eds Proceedings of the Fourth International Work-shop-Conference on Gestational Diabetes Mellitus.  Diabetes Care. 1998;  21 ((Suppl 2)) B1-B167
• 2 NICE guideline .Diabetes in Pregnancy. RCOG Press 2008
• 3 Homko C, Sivan E, Chen X. et al . Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus.  J Clin Endocrinol Metab. 2001;  86 ((2)) 568-573
• 4 Doherty DA. et al . Pre-pregnancy body mass index and pregnancy outcomes.  Int J Gynecol and Obstet. 2006;  95 ((3)) 242-247
• 5 Major CA. et al . Recurrence of gestational diabetes: who is at risk?.  Am J Obstet and Gynecol. 1998;  179 ((4)) 1038-1042
• 6 Griffin ME. et al . Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome.  Diabetic Medicine. 2000;  17 ((1)) 26-32
• 7 Scott DA. et al . Screening for gestational diabetes: a systematic review and economic evaluation.  Health Technology Assessment. 2002;  6 ((11)) 1-172
• 8 Rayner M. et al CHD Statistics: Diabetes Supplement. London, BHF 2001
• 9 Rennie KL, Jebb SA. National Prevalence of Obesity.  Obesity Reviews. 2005;  6 ((1)) 11-12
• 10 Office of National Statistics . Census. 2001;  http://www.statistics.gov.uk/census/

Correspondence