Lay summary
The Ministry of Health Gestational Diabetes Clinical Practice Guidelines (in press), recommend the addition of an HbA1c test to the 1st-antenatal blood screen to identify pregnant women with undiagnosed type 2 diabetes. In the process of screening, we will also identify women with HbA1c levels within the pre-diabetes range, but we do not know how to manage these women in pregnancy. Our previous study found that an HbA1c level in the pre-diabetes range was a marker for increased pregnancy risk such as pre-eclampsia, birth defects, birth trauma, and death of the baby. We want to compare two different treatment approaches (standard community care plus weight gain and dietary advice, versus more intense care in an antenatal diabetes clinic) to see if we can improve the pregnancy outcomes for women with early pregnancy HbA1c levels in the pre-diabetes range.