Objective: Gestational diabetes mellitus (GDM) is insulin resistance and hyperglycaemia that develops during pregnancy. Complications of GDM include macrosomia, stillbirth, neo-natal hypoglycaemia and an increased risk of future maternal type 2 diabetes. The National Institute for Health and Care Excellence (NICE) guidance makes recommendations for GDM diagnosis and management in the UK, but hospitals may differ in how they use these recommendations when writing their local guidelines. Our service evaluation aimed to explore whether and in what way local GDM guidelines in England differed between themselves and from NICE guidelines.
Design: Qualitative observational comparison of local hospital GDM guidelines.
Method: Local guidelines were requested via email from 62 English hospital Trusts with follow-up emails to non- responders. Guidelines were compared on key aspects of diagnosis, antenatal and intrapartum management and long-term diabetes testing.This study was registered as a service evaluation with Leeds Teaching Hospitals NHS Trust.
Results: Guidelines were reviewed from 13 Trusts across ten counties. Antenatally, several hospitals (8/13) included polycystic ovarian syndrome as an indication for glucose tolerance testing. Post-diagnosis GDM support varied between hospitals: 4/13 hospitals did not specify further support unless there was poor glycaemic control; one hospital offered contact details for a specialist nurse; 7/13 organised appointments with either a specialist nurse or an MDT. Only one hospital specified counselling with a specialist at 36 weeks pregnancy to discuss a birth plan. Two hospitals described specific situations for testing and management of GDM in women who had undergone specific bariatric procedures.Birthing management, including the maximum recommended gestation before induction (varying between 37 and 40+6 weeks), whether to test maternal blood sugars during labour, and treatment plans during and after birth varied, between hospitals. Variations in all hospitals followed the pattern that more prenatal treatment should decrease gestation and increase peri- and postnatal interventions. Postnatally, all hospitals included the NICE recommendation for GDM patients to have blood sugars retested six weeks after birth, however some hospitals made arrangements for an annual HbA1c while others simply recommend this.
Conclusion: Local differences in GDM testing and management guidelines allow hospitals to adapt to their local demographics. This aims to reduce underdiagnosis of GDM without excessive testing. Further research would be needed to see the effects of these guidelines on the diagnosis and treatment of GDM in the local population
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)