Diabetes guidelines for pregnancy could miss thousands of women

A report suggests that thousands of at-risk women could be missed by new criteria for diagnosing pregnancy related diabetes.

The research undertaken by Cambridge University says that although the threshold which was introduced by the health watchdog NICE earlier this year has been lowered, it is still too high.

When diabetes occurs for the first time during pregnancy, it is known as gestational diabetes. This affects around 4 to 5 per cent of pregnant women in the UK and, with the rise in obesity, is becoming increasingly common.

If the condition is left untreated, the health of the mother and baby can be put at risk, with the possibility of miscarriage, complications during labour leading to cerebral palsy, birth defects, emergency Caesarean sections and babies being born overweight.

The new guidelines brought in by NICE in February, require two blood tests, including one two hours after a sugary drink and one when fasting. A reading of 5.6 mmol per litre or above on the fasting test indicates gestational diabetes.

Guidelines from WHO (World Health Organisation) require three blood tests and a reading of 5.1 mmol per litre in the case of the fasting blood sugar test.

The author of the study Dr Claire Meek, said that there was a large difference between the two criterias.

“The international criteria are based on minimising the risk of harm to the mother and baby, whereas the NICE criteria have been based upon reducing costs to the NHS.

“While cost-effectiveness is important in any healthcare system, we must not forget the psychological and emotional distress that complications can cause.”

However, Professor Mark Baker, NICE’s clinical practice director, said that the jury was still out in relation to the World Health Organisation’s 2013 criteria.

“The expert NICE guideline development group undertook careful analysis with an economic model that showed the WHO 2013 criteria were not cost-effective; their criteria did not provide enough benefit in relation to the increased costs.

“In addition, the WHO recommendation was weak and the WHO noted that their 2013 criteria may need rapid revision as economic data becomes available.

“We welcome new research in this important area and will keep the guideline under surveillance.”

Bridget Turner, policy director at Diabetes UK, said “It is extremely important that clinicians use their clinical judgement in identifying all pregnant women who may need specific interventions to ensure safer and healthier pregnancies.

“For women diagnosed with gestational diabetes, it is vital that they receive the right information about their diagnosis as well as the support and care they need.”

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Posted by Karen Motley, Paralegal, Clinical Negligence Department, Chadwick Lawrence LLP (karenmotley@chadlaw.co.uk ), Medical negligence lawyers and clinical negligence solicitors in Huddersfield, Leeds, Wakefield and Halifax, West Yorkshire.

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