Synopsis
Coordinate preconception, antenatal, intrapartum and postnatal diabetes care to reduce maternal, fetal and neonatal harm while avoiding severe hypoglycaemia and ketoacidosis.
- Pre-existing type 1 or type 2 diabetes and gestational diabetes are distinct pathways, but all need joint obstetric–diabetes care and explicit postpartum planning.
- Offer preconception review before pregnancy where possible: optimise glucose safely, prescribe high-dose folic acid, review medicines, assess retina and kidneys, and discuss pregnancy-specific risks.
- NICE advises aiming for preconception HbA1c below 48 mmol/mol when achievable without problematic hypoglycaemia and strongly advises avoiding pregnancy when HbA1c exceeds 86 mmol/mol.
Key red flags
Nausea, vomiting, abdominal pain, dehydration, deep breathing or malaise with blood ketones can represent DKA even when glucose is not markedly raised, particularly with pump interruption or SGLT2 exposure.
Investigation priorities
Quantify recent exposure and identify a safer route into pregnancy.
Management branches
A person with diabetes could become pregnant or is actively planning conception.
- Discuss contraception until ready, pregnancy risks, glucose targets, hypoglycaemia and ketone plans, and refer promptly to the joint diabetes–pregnancy service.
- Start folic acid 5 mg daily through 12 weeks of pregnancy, optimise HbA1c safely and arrange retinal, renal, blood-pressure and medication review.
Key medicines
Folic acidTake 5 mg orally once daily before conception until 12 weeks' gestation.
MetforminInitiate and titrate under the pregnancy diabetes protocol with meals as tolerated.