Open Access Highly Accessed Research article

Quality of guidelines on the management of diabetes in pregnancy: a systematic review

Marjolein JE Greuter1, Nathalie MA van Emmerik1, Maurice GAJ Wouters2 and Maurits W van Tulder1*

Author Affiliations

1 Department of Health Sciences & EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, De Boelelaan 1085, 1081, HV Amsterdam, The Netherlands

2 Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands

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BMC Pregnancy and Childbirth 2012, 12:58  doi:10.1186/1471-2393-12-58

Published: 28 June 2012



Diabetes during pregnancy can lead to severe risks for both mother and fetus when it is not managed properly. The use of rigorously developed guidelines with a robust implementation process can have a positive influence on the management of diabetes during pregnancy. This study aims to compare recommendations and assess the quality of clinical guidelines on gestational diabetes mellitus (GDM) and pre-existing diabetes mellitus during pregnancy.


Guidelines were selected by searching PubMed, the Guideline Clearing House and Google. All guidelines developed since 2000 on diabetes during pregnancy in English or Dutch were considered. Recommendations of the guidelines were compared. Furthermore, the quality was assessed by two authors independently, using the AGREE instrument.


Eight guidelines were included. According to the AGREE instrument, the quality of most guidelines was low. The domains editorial independence, stakeholder involvement and rigour of development had the lowest scores. Recommendations were mainly comparable on glycemic control, preconceptional counseling and prenatal care and labour. Differences between recommendations were found for screening on GDM and induction of labour.


The quality of most guidelines concerning the management of diabetes during pregnancy needs to be improved. A more systematic approach in the development of these guidelines, more attention for updating procedures and piloting of the guidelines and involvement of target users and patients is recommended.

Clinical guidelines; Diabetes mellitus; Gestational diabetes; Pregnancy