When should I refer a pregnant patient to a specialist for potential complications such as gestational diabetes or preeclampsia?

Referral for Gestational Diabetes: Refer pregnant women who are identified as at risk of gestational diabetes at the first antenatal booking appointment for an oral glucose tolerance test (OGTT) between 24+0 and 28+0 weeks of gestation. This referral is based on risk assessment according to the NICE guideline on diabetes in pregnancy. If gestational diabetes is diagnosed, ongoing specialist care is required to manage the condition effectively ⁵,⁷.

Referral for Preeclampsia: At the first antenatal appointment and again in the second trimester, assess risk factors for pre-eclampsia. Women at risk should be advised to take aspirin as per NICE guidelines. Measure blood pressure at every routine face-to-face antenatal appointment using validated devices. Women with a first episode of hypertension (blood pressure ≥140/90 mmHg) after 20 weeks’ gestation should be referred to secondary care to be seen within 24 hours. Urgent referral on the same day is required for women with severe hypertension (blood pressure ≥160/110 mmHg). Any woman suspected of having pre-eclampsia, especially if presenting with symptoms such as severe headache, visual disturbances, severe pain below ribs, vomiting, breathlessness, or sudden swelling, should be referred immediately for emergency assessment in secondary care ¹,²,⁵,⁶.