Outpatient clinic for pregnancy care

The pregnancy care clinic runs once a week, on Thursday mornings. Here, women with diabetes who are pregnant, or planning a pregnancy, can seek the advice of a care team made up of a chief physician, a diabetes specialist nurse and a clinical dietician. The care covers both type 1 and type 2 diabetes.
The care team manages the treatment of the diabetes during the pregnancy, while the other routine examinations are carried out at the antenatal clinic.

Pregnancy planning
Right at the start of planning a pregnancy, in the pre-conception stage, doctors and nurses are available to advise woman on what being pregnant and having diabetes involves, in particular, what the HbA1c, the blood glucose level, should be around the time of conception. The aim of pregnancy planning is to avoid unplanned pregnancies where diabetes management has not been considered. For women with type 2 diabetes who are planning a pregnancy, tablet treatment is often replaced by insulin injections, as tablet treatment can have a detrimental effect on the fetus. Other medication is checked and changed if necessary.

Risk prevention
Women with diabetes have a higher risk of developing pre-eclampsia, giving birth prematurely and giving birth to very large infants. In rare case, fetal malformations occur. The risk of complications can be decreased by careful regulation of blood glucose (e.g. by monitoring levels at least four times a day) and by maintaining normal blood pressure.

Check-ups in the outpatient clinic for pregnancy care
Women are referred to the pregnancy care clinic once the pregnancy has been confirmed. They are offered an eye examination (retinal examination) and a urine- and blood test. These examinations are repeated in the 26th week of pregnancy and again two months after the woman has given birth. From the very start of the pregnancy, women are encouraged to keep a pregnancy diary and to monitor their blood glucose four times a day.

A typical visit
At every visit the woman’s blood pressure and blood glucose (Hba1c) are measured and an assessment is made of albuminuria (protein in urine). The woman’s self-monitored blood glucose levels are checked by either a physician or nurse, and treatment is adjusted accordingly. The diabetes team give any necessary information and advice related to the pregnancy, in particular concerning how reactions to and the need for insulin change during the course of a pregnancy. Women are shown how to adjust their insulin dose in line with their blood glucose reading, and are encouraged to discuss any care or dietary concerns they may have.

Post-natal home visits
Approximately 14 days after giving birth, women with type 1 diabetes who live in Copenhagen County receive a home visit from a diabetes nurse. Two months after giving birth, they have a last check-up at the outpatient clinic for pregnancy care before being signed off. The forthcoming check-ups are done in the outpatient clinic or by the woman’s own general practitioner.