32 | Nursing in Practice | Spring 2022
CLINICAL
The latest clinical guidance in general practice and community nursing nursingin practicelearning . co . uk
DIABETES IN PREGNANCY
The primary care nurse role
2CPD HOURS
Key points
• Nurses in primary care have an important role in helping to provide preconception and postpartum advice and support to women with diabetes .
• Secondary care referral is essential for any woman with pre-existing diabetes who is planning a pregnancy , to avoid adverse pregnancy outcomes for both mother and developing baby .
• Women should remain on contraception until advice from specialists has been sought , medications have been reviewed and target HbA1c levels reached .
• The postpartum period is an opportune time to remind women with gestational diabetes about lifestyle changes that can reduce their risk of future type 2 diabetes .
The risks of diabetes during pregnancy Recent research found only one in five women with diabetes is prepared for a pregnancy . 1 Yet diabetes in pregnancy is associated with major health risks for the mother and the growing foetus . Risks and complications include congenital abnormalities , stillbirth and perinatal death . 2 In addition , the incidence of type 2 diabetes among women of childbearing age is increasing . 3
Pregnancy in women with diabetes is considered high risk – this applies to pre-existing diabetes and to gestational diabetes , which arises during pregnancy .
This means the pregnancy must be managed in secondary care by a joint diabetes and obstetrics antenatal clinic led by a consultant obstetrician and consultant diabetologist , with a team including a diabetes specialist nurse , midwife and dietitian , in accordance with NICE guidelines . 4
Primary care nurses must refer women with diabetes who are pregnant , or who are planning to get pregnant , to the relevant specialist team for early intervention .
However , primary care nurses themselves have an important role in preconception care , particularly in counselling patients about the importance of achieving good glycaemic control prior to conceiving .
They also support postpartum management , for example in helping patients to achieve safe glycaemic targets , ensuring appropriate contraception and carrying out postnatal diabetes checks for women who developed gestational diabetes . This module will help primary care nurses to :
• Understand the importance of preconception advice and management for women with diabetes .
• Improve evidence-based knowledge of diabetesmanagement options before , during and after pregnancy .
• Understand the role and limitations of practice nurses in preconception , pregnancy and postpartum care of women with diabetes .
• Gain confidence in advising and supporting women with diabetes in planning a pregnancy and in raising awareness of the risks of unplanned pregnancy .
Preconception care for women with diabetes All women of childbearing age with diabetes should be counselled in primary care about planning pregnancy
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