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.