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
...Preconce...
...Preconception...
....1. The Endocrine Society (ES) recom...
...Preconception Glyce...
...suggests women with diabetes seeking...
...Insulin T...
...ends insulin-treated women with diabetes...
...sts a change to a woman’s insulin reg...
....3c. ES suggests insulin-treated wo...
...3d. ES suggests women with diabetes succ...
...Folic Acid Supplementatio...
....4. ES recommends, beginning 3 month...
...uggests a daily dose of 5 mg based on t...
...Ocular Care (...
...a. ES recommends all women with diabetes who...
...if retinopathy is documented, the patient...
...recommends women with established...
....5c. ES suggests pregnant women with dia...
...Renal Function (precon...
...suggests all women with diabetes consi...
...t a woman with diabetes who has a significantly re...
....6b. ES suggests all women with diabe...
...Management...
...ES recommends satisfactory BP c...
1.7b. ES recommends a woman with di...
1.7c. ES suggests in the exceptional case...
...d. ES recommends when ACE inhibitors or AR...
...Elevated V...
.... ES recommends that if a woman with diabetes...
...8b. ES recommends if a woman with diab...
...Management of Dyslipide...
....9a. ES recommends against the use of statins in w...
...In view of their unproven safety dur...
...suggests bile acid-binding resins may be used...
...Thyroid F...
...en with type 1 diabetes seeking concepti...
...Overweight an...
...ecommends weight reduction before...
Care During Pregnancy
...Care During Pregnancy...
...Testing for Overt...
...mends universal testing for diabetes (see Table...
...Testing for Gestation...
....2. ES recommends pregnant women not previousl...
...that gestational diabetes be diagnosed wi...
...ble 1. Diagnostic Criteria for Overt Diab...
.... Diagnostic Criteria for Overt Diabetes an...
Ma...
...commends women with gestational diab...
...mmends the initial treatment of gestational di...
...nds using blood glucose-lowering ph...
...3.0 Glucose Monito...
...Self-monitoring...
...ommends self-monitoring of blood glucose in a...
...ting before and either 1 or 2 hours afte...
...Glycemic T...
...ecommends pregnant women with overt or gestation...
...r other meals)700...
...s that an even lower fasting blood...
...gests pregnant women with overt or...
...suggests pregnant women with overt...
...Con...
...uggests that continuous glucose monitorin...
...Preconception Glycemic Targets for Women With Ove...
...4.0. Nutrit...
...Nutriti...
...recommends MNT for all pregnant wom...
...Weight M...
4.2a. ES suggests women with overt or gestati...
...gests obese women with overt or ge...
...Carbohydra...
...suggests women with overt or gestational...
...IOM Recommendations for Total Weight Gai...
...Nutritiona...
...recommends pregnant women with overt or gesta...
...sts the dose of folic acid be reduced...
...5.0. Blood Glucose-Loweri...
...Insulin Th...
...1a. ES suggests the long-acting in...
...S suggests those pregnant women succe...
...uggests the rapid-acting insulin analogs lispro an...
....1d. ES recommends the ongoing use of continuous...
...ts that continuous SC insulin infu...
...Noninsul...
5.2a. ES suggests glyburide (glibenclam...
...2b. ES suggests metformin therapy be us...
Intra- and Postpartum Care
...Intra- an...
...6.0 Labor, Delivery...
...Blood Glucose Targ...
...gests target blood glucose levels of 72-126 mg/dL...
...Lactation...
...S recommends women with overt or gestational d...
...b. ES recommends women with overt diabetes who...
...Postpart...
6.3. ES recommends the choice of a co...
...Screening for Pos...
...ests women with type 1 diabetes be screened f...
...Post...
...mmends postpartum care for women who have ha...
...b. ES recommends a 2-hour, 75-g OGT...
...are normal, we recommend this or othe...
...ests the child’s birth weight and...
...d. ES recommends all women who hav...
2.4e. ES suggests blood glucose-lo...