Gestational diabetes occurs in 4-5% of pregnancies, and many women who develop gestational diabetes return to normoglycaemia after the birth of their baby. However there is a high risk of future type 2 diabetes, as high as 50%. Therefore it is essential that they are offered a 12 week HbA1c* AND that they remain on the at risk register for type 2 diabetes.
*(12 week HbA1c is preferable to a 6 week fasting glucose, particularly in breastfeeding women)
Post-natal screening
Current established practice for Lothian patients is a 12 week HbA1c :
- St Johns patients – via their local general practice.
- RIE – Screening offered at Lauriston although some women chose to attend their GP instead (DNA letters sent from RIE team to those who don’t attend Lauriston).
- WGH – Screening offered at WGH (reasonably good uptake – up to 2 appointments offered then letter with advice to patient)
The MCN would recommend that to ensure ongoing annual HbA1c that practices code as both:
Gestational diabetesL1809
and
High risk of diabetes annual review** 66AZ
Risk of progression to T2DM
Around half of women affected by gestational diabetes go on to progress to T2DM without intervention. They will be offered a wellbeing review from the Dietitian post-partum, and type 2 diabetes prevention education will be discussed and offered. The patients can engage in education but remain welcome at LPD courses at any point in the future.. Healthy diet and an active lifestyle (including better sleep and stress management) with the goal of weight loss or maintaining a healthy BMI are the main focus of reducing this risk, see pre-diabetes<Pre-Diabetes – RefHelp> section for more detail.
Subsequent Pregnancy
There is an increased risk of having gestational diabetes in any subsequent pregnancies so women are advised to seek medical advice before planning another pregnancy. Good overall health in the pre-conception period is vital. See Recommendations | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE
Who to refer:
Those with GDM who have accepted postnatal wellbeing review from a Dietitian are offered diabetes prevention education as part of the Lothian GDM Pathway.
There may be people with a history of previous GDM some years ago, direct referrals to the type 2 diabetes prevention programme are welcomed at any time from this cohort
How to refer:
via SCI gateway (WGH/RIE/SJH > Diabetes)
See Pre-Diabetes – RefHelp (nhslothian.scot) page for approach
Consider also referral to the gestational diabetes specific arm of the app My Desmond (Babysteps) Platform via weight management referral. MyDesmond | Prevent or Manage Type 2 Diabetes
