Diabetes and Pregnancy
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
...conception Ca...
...n Care of Women with Diabetes...
...docrine Society (ES) recommends preconception...
...reconception Glycemic C...
.... ES suggests women with diabetes s...
...sulin Therapy...
...recommends insulin-treated women with...
...uggests a change to a woman’s insulin...
...suggests insulin-treated women with dia...
...3d. ES suggests women with diabetes...
...ic Acid Supplementat...
...mmends, beginning 3 months before withdrawin...
...a daily dose of 5 mg based on this dose’s...
...lar Care (preconception, during pr...
...ommends all women with diabetes who are seekin...
...tinopathy is documented, the patient should be...
...S recommends women with established retin...
1.5c. ES suggests pregnant women with d...
...al Function (preconception and during p...
...s all women with diabetes considering pregnan...
...suggests that a woman with diabetes who has a...
...s all women with diabetes and preconception rena...
...gement of Hypertension
...ends satisfactory BP control (...
...ommends a woman with diabetes who is see...
...ests in the exceptional case where the d...
...mends when ACE inhibitors or ARBs have been contin...
...evated Vascular R...
.... ES recommends that if a woman with diabetes...
1.8b. ES recommends if a woman with diabetes is s...
...nagement of Dyslipidemia...
...nds against the use of statins in women wit...
...In view of their unproven safety du...
...ES suggests bile acid-binding resins ma...
...id Function...
1.10. For women with type 1 diabetes seeking co...
...ght and Obesity...
...mmends weight reduction before pregnancy fo...
Care During Pregnancy
...re During Pregn...
...Overt Diabetes in Early Pregnancy...
...ds universal testing for diabetes (see Table 1) w...
Testing for Gestational Diabetes at 24-28 We...
...2. ES recommends pregnant women not pr...
...nds that gestational diabetes be diagnosed w...
...agnostic Criteria for Overt Diabetes and...
Table 2. Diagnostic Criteria for Overt...
...of Elevated Blood Glucose...
...ommends women with gestational diabet...
.... ES recommends the initial treatm...
...ecommends using blood glucose-lowering pharmac...
...ucose Monitoring and Glycemic Tar...
...lf-monitoring of Blood Glucose...
...ecommends self-monitoring of blood...
...d suggests testing before and either 1 or...
...lycemic Targets (Tab...
3.2a. ES recommends pregnant women with overt or g...
...for other meal...
...2b. ES suggests that an even lower fasting blood g...
...c. ES suggests pregnant women with overt o...
...s pregnant women with overt diabetes strive to ac...
...ous Glucose Monitoring...
...that continuous glucose monitoring be...
...able 3. Preconception Glycemic Targets for Wom...
...Nutrition Therapy and Weight Gain T...
...trition Ther...
...ends MNT for all pregnant women with overt or...
...ht Management...
...sts women with overt or gestational diabetes follo...
4.2b. ES suggests obese women with overt or ges...
...arbohydrate In...
...s women with overt or gestational diabete...
...able 4. 2009 IOM Recommendations for Total...
...onal Supplements...
.... ES recommends pregnant women with ove...
...ests the dose of folic acid be reduc...
...Blood Glucose-Lowering Pharmacological Therapy Dur...
...nsulin Ther...
...S suggests the long-acting insulin...
...suggests those pregnant women success...
...sts the rapid-acting insulin analo...
...ends the ongoing use of continuous SC...
...ests that continuous SC insulin infusion NOT b...
...ninsulin Antihyperglycemic Agen...
...ggests glyburide (glibenclamide) is a...
...b. ES suggests metformin therapy b...
Intra- and Postpartum Care
...tra- and Postpartum Care...
...0 Labor, Delivery, Lactation, and Pos...
Blood Glucose Targets During Labor and Delivery
...target blood glucose levels of 72-126...
Lactat...
...2a. ES recommends women with overt or gestatio...
...recommends women with overt diabetes who...
...tum Contraception
....3. ES recommends the choice of a c...
...or Postpartum Thyroiditis...
...4. ES suggests women with type 1 diabetes be scree...
...tpartum Care...
...S recommends postpartum care for wo...
...recommends a 2-hour, 75-g OGTT should...
...results are normal, we recommend this...
...gests the child’s birth weight and wh...
...d. ES recommends all women who have had...
...ES suggests blood glucose-lowerin...