Summary

Women with diabetes in pregnancy have their blood sugar levels closely monitored during labour in order to minimise the effects of high sugar on their baby after birth. High blood sugar in the mother can cause low blood sugar in the baby. However, this monitoring is intrusive and expensive. New evidence suggests that it may not be as important for preventing problems in the baby as previously thought. This is an important issue as diabetes in pregnancy is increasing in the UK. It currently affects 5% of all pregnant women. Most have gestational diabetes, which develops during pregnancy and goes away after birth, with the rest having diabetes before they get pregnant. 

The GILD study aimed to design a future randomised clinical trial to compare blood sugar monitoring strategies via a four-stage scoping programme of work. The study collected current clinical guidelines for monitoring blood sugar, surveyed health care professionals regarding current practice and training needs, surveyed women regarding their experience of birth with diabetes, collected data regarding prevalence and issues with blood sugar monitoring, and conducted a Delphi survey to reach consensus on key aspects of a future clinical trial. A clinical trial was then designed and a qualitative study was undertaken, interviewing women and health professionals, to ascertain the acceptability of a future trial design.

This study included participation from women with experience of labour in diabetes, women who were pregnant with diabetes and a range of health care professionals including midwives, obstetricians, neonatologists and endocrinologists.

A clinical trial comparing a 'tight' and 'less tight' blood glucose monitoring strategy was designed and generally found acceptable to women and health professionals.