The following outlines the care that all women will receive in the Joint Diabetic ANC.
2.2.1. Timetable of antenatal appointments and additional information regarding diabetes in pregnancy care is included in the Diabetes is Pregnancy supplementary or the booklets added to green handheld notes.
In addition to this they will require their normal antenatal care by their community midwife.
Women will be given appointments for the Joint Diabetic antenatal clinic at a frequency that will be determined by their diabetic control and their individual needs.
2.2.2. Women with type 1 DM will be offered the use of hybrid closed loop therapy (HCL) for the duration of their pregnancy. They will need to maintain a supply of insulin pens, needles, bloods glucose meter and test strips in the event of technology failure or illness. Those with Type 2 DM on multiple daily injections will be offered a continuous glucose sensor for the duration of their pregnancy (CGM). Women with Type 2 DM Women managing on diet/exercise alone or treated with oral therapy, or single dose intermediate or long-acting insulin should test fasting and 1 hour after meals.
2.2.3. Advise pregnant women with any form of diabetes to maintain CBG below the following targets:
2.2.4. Women with Type 1 DM are offered blood ketone testing strips and advised to test for ketonaemia and to seek urgent medical advice if they become hyperglycaemic or unwell. They will all be advised of the risks of hypoglycaemia and the potential for unawareness of this in pregnancy. All diabetic women with Type 1 DM are given glucagon and instructed on how to use it, along with information on sick day rules.
2.2.5. If the woman is planning to breastfeed antenatal expressing will be recommended from 36 weeks' gestation.
2.2.6. The care of women with Type 1 or Type 2 Diabetes and retinopathy which requires treatment during pregnancy and/or renal impairment (CKD 2 and PCR>30 OR CKD 3 or more) should be planned with the regional maternal medicine centre in Bristol. This may be by ongoing Multi-disciplinary Team discussions throughout the pregnancy in collaboration with RCHT Maternal medicine consultant at the Southwest Maternal Medicine network meeting.