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
...onception Care...
...econception Care of Women with Diabetes
...Endocrine Society (ES) recommends preconception co...
...tion Glycemic Control...
...2. ES suggests women with diabetes seeking to...
...ulin Therapy...
...ecommends insulin-treated women with diabetes...
...ES suggests a change to a woman’s insulin regim...
...suggests insulin-treated women with diabetes seek...
...suggests women with diabetes success...
...ic Acid Supplementation...
...ends, beginning 3 months before withdrawing co...
...aily dose of 5 mg based on this dose’...
...conception, during pregnancy, and postpart...
.... ES recommends all women with diabetes who a...
...hy is documented, the patient should be appr...
....5b. ES recommends women with esta...
...suggests pregnant women with diabetes not...
...nal Function (preconception and during pregnan...
1.6a. ES suggests all women with diabetes consider...
...suggests that a woman with diabetes who has...
...ts all women with diabetes and preco...
...agement of Hypertension...
...mends satisfactory BP control (...
...S recommends a woman with diabetes who is seeking...
...S suggests in the exceptional case...
...S recommends when ACE inhibitors or ARBs have been...
...evated Vascular Risk...
...ommends that if a woman with diabetes has suf...
...8b. ES recommends if a woman with diabetes is see...
...agement of Dyslipi...
...mmends against the use of statins...
...9b. In view of their unproven safety...
1.9c. ES suggests bile acid-binding resins may be...
...roid Function...
...with type 1 diabetes seeking conception, ES...
...verweight and Obesi...
1.11. ES recommends weight reduction...
Care During Pregnancy
Care During Preg...
...rt Diabetes in Early Pregnancy...
...1. ES recommends universal testing for diabetes (...
...esting for Gestational Diabetes at 24-28 Week...
...nds pregnant women not previously identified (e...
...that gestational diabetes be diagnosed...
.... Diagnostic Criteria for Overt Diabetes and Ges...
...nostic Criteria for Overt Diabetes and Gestational...
...anagement of Elevated Blood Glucose
...a. ES recommends women with gestatio...
...3b. ES recommends the initial treatment o...
...recommends using blood glucose-lowering...
...Glucose Monitoring and Glycemic Targets
...nitoring of Blood Gluco...
...S recommends self-monitoring of blood gl...
and suggests testing before and either 1 or 2 hour...
...mic Targets (Table 3)...
...ommends pregnant women with overt or gesta...
...r other meals)700...
...S suggests that an even lower fasting b...
...ts pregnant women with overt or gestation...
...suggests pregnant women with overt diabetes...
...ntinuous Glucose Monitoring...
...ests that continuous glucose monitoring be used...
.... Preconception Glycemic Targets for Women W...
...ion Therapy and Weight Gain Targets for Women...
...rition Therapy
4.1. ES recommends MNT for all pregnant...
...ght Manageme...
...s women with overt or gestational d...
4.2b. ES suggests obese women with...
...arbohydrate Intak...
...3. ES suggests women with overt or g...
...2009 IOM Recommendations for Total Weigh...
...utritional Supplemen...
4.4a. ES recommends pregnant women with overt or...
...ggests the dose of folic acid be reduced to...
...ose-Lowering Pharmacological Therapy Durin...
...in Therapy...
...uggests the long-acting insulin anal...
...s those pregnant women successfully using i...
...uggests the rapid-acting insulin analogs lispr...
...recommends the ongoing use of continuous SC ins...
...suggests that continuous SC insulin infusion NO...
...sulin Antihyperglycemic Agent Therapy...
...gests glyburide (glibenclamide) is a suitable...
...gests metformin therapy be used for glycem...
Intra- and Postpartum Care
...ra- and Postpartum Ca...
...elivery, Lactation, and Postpartum Care...
...Glucose Targets During Labor and Delivery...
...uggests target blood glucose levels o...
...tation...
...S recommends women with overt or gestationa...
...mends women with overt diabetes who are breastfee...
...tpartum Contrace...
...nds the choice of a contraceptive method for a wom...
...ng for Postpartum Thyroiditis...
...ests women with type 1 diabetes be sc...
...tpartum Ca...
.... ES recommends postpartum care for women w...
...nds a 2-hour, 75-g OGTT should be undertaken...
...normal, we recommend this or other d...
.... ES suggests the child’s birth weight and wh...
...nds all women who have had gestational...
...ggests blood glucose-lowering medication...