Postnatal care in gestational diabetes - including further glucose screening

Postnatal care:

• women who were diagnosed with gestational diabetes should be offered lifestyle advice (including weight control, diet and exercise) and offered a fasting plasma glucose measurement (but not an oral glucose tolerance test) at the 6-week postnatal check and annually thereafter
  • women who were diagnosed with gestational diabetes (including those with ongoing impaired glucose regulation) should be informed about the risks of gestational diabetes in future

Breastfeeding and effects on glycaemic control

• women with insulin-treated pre-existing diabetes should reduce their insulin immediately after birth and monitor their blood glucose levels carefully to establish the appropriate dose
• women with insulin-treated pre-existing diabetes should be informed that they are at increased risk of hypoglycaemia in the postnatal period, especially when breastfeeding, and they should be advised to have a meal or snack available before or during feeds
• women who have been diagnosed with gestational diabetes should discontinue hypoglycaemic treatment immediately after birth.
• women with pre-existing type 2 diabetes who are breastfeeding can resume or continue to take metformin and glibenclamide immediately following birth but other oral hypoglycaemic agents should be avoided while breastfeeding

Reference:

• (1) NICE (March 2008). Diabetes in pregnancy Management of diabetes and its complications from pre-conception to the postnatal period