My Pregnancy

HbA1c 

at booking and 2nd and 3rd trimester

Renal assessment 

Arrange at booking if not been done in last 3 months

Refer to nephrologist if

– Serum creatinine greater than 120 mmol/ L or

– Serum creatinine: albumin ratio more than 30 mg/ mmol

– Total protein excretion exceeds 0.5 gm / day

Consider thromboprophylaxis if nephrotic range proteinuria above 5 gm/  (albumin: creatinine ratio more than 220 mg/ mmol)

Retinal assessment 

– Offer retinal assessment by digital imaging with mydriasis using tropicamide  at first visit unless they have it in last 3 months. 

– Diabetic retinopathy not a contraindication to rapid optimization of blood sugar control if High HbA1C in early pregnancy.

– If diabetic retinopathy then additional assessment needed at 16- 20 weeks and 28 weeks.

– Diabetic retinopathy not a contraindication to vaginal delivery.