postnatal care in gestational diabetes - including further glucose screening

Last reviewed 05/2023

Women who have been diagnosed with gestational diabetes should discontinue blood glucose-lowering therapy immediately after birth - this will be done via specialist advice.

For women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after the birth:

  • offer lifestyle advice (including weight control, diet and exercise)

  • offer a fasting plasma glucose test 6-13 weeks after the birth to exclude diabetes (for practical reasons this might take place at the 6-week postnatal check)

  • if a fasting plasma glucose test has not been performed by 13 weeks, offer a fasting plasma glucose test, or an HbA1c test if a fasting plasma glucose test is not possible, after 13 weeks

  • do not routinely offer a 75 g 2-hour OGTT

For women having a fasting plasma glucose test as the postnatal test:

  • women with a fasting plasma glucose level below 6.0 mmol/litre should be advised that:
    • have a low probability of having diabetes at present
    • should continue to follow the lifestyle advice (including weight control, diet and exercise) given after the birth
    • will need an annual test to check that their blood glucose levels are normal
    • have a moderate risk of developing type 2 diabetes
  • women with a fasting plasma glucose level between 6.0 and 6.9 mmol/litre should be advised that
    • are at high risk of developing type 2 diabetes, and offer them advice, guidance and interventions in line with the NICE guideline on preventing type 2 diabetes
  • women with a fasting plasma glucose level of 7.0 mmol/litre or above should be advised that
    • are likely to have type 2 diabetes, and offer them a diagnostic test to confirm diabetes

For women having an HbA1c test as the postnatal test:

  • women with an HbA1c level below 39 mmol/mol (5.7%) should be advised that:
    • have a low probability of having diabetes at present
    • should continue to follow the lifestyle advice (including weight control, diet and exercise) given after the birth
    • will need an annual test to check that their blood glucose levels are normal
    • have a moderate risk of developing type 2 diabetes, and offer them advice and guidance in line with the NICE guideline on preventing type 2 diabetes

  • women with an HbA1c level between 39 and 47 mmol/mol (5.7% and 6.4%) should be
    • advised that they are at high risk of developing type 2 diabetes, and offer them advice, guidance and interventions in line with the NICE guideline on preventing type 2 diabetes

  • women with an HbA1c level of 48 mmol/mol (6.5%) or above should be
    • advised that they have type 2 diabetes and refer them for further care

Offer an annual HbA1c test to women who were diagnosed with gestational diabetes who have a negative postnatal test for diabetes

Subsequent pregnancies:

  • women who were diagnosed with gestational diabetes should be offered early self-monitoring of blood glucose or an OGTT in future pregnancies
    • offer a subsequent OGTT if the first OGTT results in early pregnancy are normal

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:

Related pages:

gestational diabetes