Appendix 4. Practice summary: Diabetes in pregnancy

When: Assess risk of undiagnosed diabetes or prediabetes at the first antenatal visit and offer testing to women with risk factors

At 24–28 weeks offer testing to women not already tested and repeat testing to women with risk factors with a previous normal blood glucose level

Who: Midwife; GP; obstetrician; Aboriginal and Torres Strait Islander Health Practitioner; Aboriginal and Torres Strait Islander Health Worker; multicultural health worker; accredited practising dietitian, diabetes educator; endocrinologist; accredited exercise physiologist

• Discuss the reasons for testing blood glucose levels: Explain that diabetes in pregnancy can have effects on the pregnancy and the baby and that early identification and taking steps to manage raised blood glucose as soon as possible can reduce the risk of these effects.
• Take a holistic approach: Provide women with practical advice on healthy eating and physical activity [...], taking into consideration the availability of foods and ways of being physically active that are appropriate to the woman’s cultural practices and preferences. Consider a health promotion program to improve community understanding of the effects of diabetes in pregnancy and the importance of healthy lifestyle patterns.
• Consider referral: Where possible, women diagnosed with pre-existing diabetes should be referred for specialist assessment (by an endocrinologist or obstetric physician) and education on nutrition, monitoring and management (eg to a multidisciplinary team involving an accredited practising dietitian, diabetes educator, endocrinologist, obstetric physician). Where specialist allied health professionals are not available, other sources of information (eg written information, video or audio resources, telehealth services) may be useful.
• Document and follow up: When a woman’s blood glucose is tested, tell her the results and note them in her antenatal record. Have a system in place so that women diagnosed with diabetes receive ongoing follow-up, including further testing of blood glucose levels after pregnancy. Postnatal education and support are important in preventing or delaying the onset of diabetes in the future and women should be encouraged to attend postnatal testing.