DCPNS has created this clinical resource to support health care providers to adopt recognized Clinical Practice Guidelines into practice for the management of pregnancy complicated by diabetes. Covering the preconception to the postpartum periods for individuals with pre-existing diabetes (type 1, type 2, or MODY) or gestational diabetes mellitus (GDM), this resource profiles practice approaches that support optimal pregnancy outcomes.

• Pregnancy and Diabetes: Approaches to Practice (2021)

The purpose of this resource is to:​​​​​​ 

• Encourage discussion and review of current practice.
• Support the adoption of a consistent evidence informed approach to the planning and management of pregnancy and diabetes.
• Improve pregnancy experiences and outcomes for the individual living with diabetes.

The recommendation and approaches included within this document are not intended to replace individual clinical judgement.

Accompanying patient pamphlets are available on NSH library services:

• Screening for Diabetes During Pregnancy (.pdf)
  ENGLISH | FRENCH | ARABIC
• Screening for Diabetes After Pregnancy (.pdf)
  ENGLISH | FRENCH | ARABIC 
• I Have Diabetes and I Can Have a Healthy Baby! Pregnancy Information for Individuals with Type 1 or Type 2 Diabetes (.pdf)
  ENGLISH | FRENCH | ARABIC

Webinar series live sessions:

• Overview of ‘DCPNS Pregnancy and Diabetes: Approaches to Practice 2021’ revised resources, with Q & A (53:31 min)
• Reproductive Care Program of Nova Scotia’s New Approach to GDM Screening (35 min)

Guidelines:

• GDM Screening Practice Resource and Algorithm - February 2022
• Diabetes and Pregnancy - 2018

Key Message for Health Care Providers:
The number of pregnancies complicated by diabetes (pre-existing type 1 or type 2 diabetes and GDM) is increasing.  In Nova Scotia, GDM is reported to account for 9.5% of all deliveries*¹ and the rates are expected to continue to increase with more attention given to early screening, new diagnostic criteria, increasing maternal age, and higher rates of overweight individuals and obesity.  GDM rates are higher in Nova Scotia Mi’kmaq communities (15% in 2016)², and in African Nova Scotian and some Newcomer populations, including those of African, Arab, Asian, Hispanic, or South Asian descent.³  These communities face unique barriers and challenges related to diabetes prevention and management that are compounded by systemic racism.  To help mitigate these challenges, approaches to care should be patient and family centered, culturally safe, trauma informed, and inclusive.

The management of pregnancy complicated by diabetes can be complex and intensive, requiring immediate and ongoing support from a qualified team.  The best care involves an interprofessional team that includes diabetes specialists (endocrinologists and internists), diabetes educators (nurses and dietitians), obstetrical care providers, and others.

Appendices found within the resource by chapter:

Chapter 2: Screening for overt diabetes and gestational diabetes

• Diagnostic Criteria Using a 2-hour 75-g Oral Glucose Tolerance Test (OGTT) for the Non-Pregnant Population: Proper Preparation and Conditions
• Diagnostic Criteria for GDM Using the Preferred 2-step approach: 50-g GCT followed by 2-hour 75-g OGTT Proper Preparation and Conditions

Chapter 4: Psychosocial considerations

• Diabetes Distress Scale: 2-Item Screener (DDS-2)
• Indications for Referral to a Social Worker and/or Mental Health Practitioner

Chapter 5: Nutrition

• US National Academy of Medicine (NAM) Gestational Weight Gain Recommendations
• Prenatal Weight Gain Charts

Chapter 6: Physical Activity

• Canadian Society for Exercise Physiology (CSEP) Get Active Questionnaire for Pregnancy
• CSEP Health Care Provider Consultation Form for Prenatal Physical Activity
• Joint SOGC/CSEP Heart Rate Ranges and Modified Heart Rate Ranges
• Borg’s Rating of Perceived Exertion (RPE) Scale

Chapter 7: Insulin and non-insulin therapies

• Pump Therapy

Chapter 9: Monitoring ketones

• Blood Ketone Management (Adopt from NHS)

Chapter 10: Hypoglycemia

• Treatment of Mild or Moderate Hypoglycemia
• Treatment of Severe Hypoglycemia

Chapter 12: Newborn Care

• Canadian Pediatric Society (CPS) Algorithm for the Screening and Immediate Management of Babies at Risk for Neonatal Hypoglycemia

Chapter 13: Postpartum

• Monitoring Glycemia and Insulin Requirements: Immediate Postpartum and Post Discharge
• Diagnostic Criteria Using a 2-hour 75-g OGTT: Proper Preparation and Conditions
• Diagnostic Criteria Using a 2-hour 75-g Oral Glucose Tolerance Test (OGTT) for the Non-Pregnant Population: Proper Preparation and Conditions