Diabetes and Pregnancy

Publication Date: October 31, 2013

Key Points

Key Points

  • Maternal hyperglycemia in the first few weeks of pregnancy increases the risk of fetal malformations, spontaneous abortions, and perinatal mortality.
  • There is a continuous graded relationship between higher maternal glucose and increasing frequency of caesarian section, preeclampsia, fetal macrosomia, and fetal morbidity.
  • Before conception, glycemic control should be as close to normal as possible when this can be safely achieved.
  • At the first prenatal visit (before 13 weeks gestation or as soon as possible thereafter) all women not known to already have diabetes should be tested for diabetes.
  • At 24-28 weeks gestation, all pregnant women not known to already have gestational or overt diabetes should be tested for gestational diabetes.

Preconception Care

...ception Care...

...eption Care of Women with Diabetes

...he Endocrine Society (ES) recommends preco...

...ion Glycemic Control...

...uggests women with diabetes seeking...

...lin Therapy...

...recommends insulin-treated women with dia...

...gests a change to a woman’s insulin regimen, p...

...ggests insulin-treated women with...

...gests women with diabetes successfully u...

Folic Acid Supplem...

...ES recommends, beginning 3 months bef...

...gests a daily dose of 5 mg based on this doseâ€...

...conception, during pregnancy, and postpar...

...5a. ES recommends all women with diabetes who are...

...nopathy is documented, the patient...

...ES recommends women with establis...

...suggests pregnant women with diabetes not...

...nction (preconception and during p...

.... ES suggests all women with diabetes consider...

...suggests that a woman with diabetes w...

...ES suggests all women with diabete...

...gement of Hypertension...

...mmends satisfactory BP control (...

...S recommends a woman with diabetes who is see...

...s in the exceptional case where the degre...

....7d. ES recommends when ACE inhibitors or...

...d Vascular Risk...

...S recommends that if a woman with diabetes has su...

.... ES recommends if a woman with diabet...


...agement of Dyslipidemia...

...a. ES recommends against the use of statins in...

....9b. In view of their unproven safety during pre...

.... ES suggests bile acid-binding resins may be use...


...oid Function...

...men with type 1 diabetes seeking concept...


...ight and Obesity

...ecommends weight reduction before pregnancy for o...


Care During Pregnancy

...e During Pregnanc...

...for Overt Diabetes in Early Preg...

...ommends universal testing for diabetes...


...ing for Gestational Diabetes at 24-28 Weeks...

...mmends pregnant women not previously id...

...at gestational diabetes be diagnosed with th...


...gnostic Criteria for Overt Diabetes and Gestati...


Table 2. Diagnostic Criteria for O...


...anagement of Elevated Blood Glucos...

...mmends women with gestational diabetes target...

...commends the initial treatment of gestational d...

...ES recommends using blood glucose-loweri...


...ucose Monitoring and Glycemic Targ...

Self-monitoring of Blood Glucose

...ecommends self-monitoring of blood gl...

...nd suggests testing before and eithe...

...emic Targets (Table 3)...

....2a. ES recommends pregnant women with overt or ge...

...for other meals)700

...suggests that an even lower fasting bl...

...suggests pregnant women with overt or...

...uggests pregnant women with overt d...

...tinuous Glucose Monitoring

3.3. ES suggests that continuous glucose...


Table 3. Preconception Glycemic Targets for Women...


...ion Therapy and Weight Gain Targets for Women With...

...rition Therap...

...1. ES recommends MNT for all pregnant women wit...

...ight Management

...ts women with overt or gestational diabetes foll...

...b. ES suggests obese women with overt or gestat...

...ydrate Intake...

...ES suggests women with overt or gestational...

...able 4. 2009 IOM Recommendations for Tot...

...ritional Supplemen...

...4a. ES recommends pregnant women with overt or...

...uggests the dose of folic acid be reduced...


...lood Glucose-Lowering Pharmacological Thera...

...in Therapy...

...ggests the long-acting insulin analog det...

...ES suggests those pregnant women successfu...

...c. ES suggests the rapid-acting insulin analogs...

5.1d. ES recommends the ongoing use of co...

...ts that continuous SC insulin infusion...

...tihyperglycemic Agent Therapy

...s glyburide (glibenclamide) is a s...

...ests metformin therapy be used for glycemic contr...


Intra- and Postpartum Care

...and Postpartum Care...

...bor, Delivery, Lactation, and Post...

...cose Targets During Labor and Deliv...

...suggests target blood glucose levels of 72-1...

Lactation

...2a. ES recommends women with overt or gestation...

....2b. ES recommends women with over...

...artum Contracept...

...ES recommends the choice of a contraceptive me...

...ng for Postpartum Thyroiditis...

...ts women with type 1 diabetes be screened for...

...ostpartum Car...

...mmends postpartum care for women who have...

2.4b. ES recommends a 2-hour, 75-g OGTT should be...

...normal, we recommend this or other diagnostic...

2.4c. ES suggests the child’s bir...

2.4d. ES recommends all women who have...

...s blood glucose-lowering medication should be d...