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
...econception Care...
...econception Care of Women with...
...e Endocrine Society (ES) recommends preconception...
Preconception Glycemic C...
...2. ES suggests women with diabetes se...
...lin Therapy...
...ES recommends insulin-treated women with diabetes...
....3b. ES suggests a change to a woman’s insulin...
.... ES suggests insulin-treated women with diabetes...
...suggests women with diabetes successfully using t...
...id Supplementation
....4. ES recommends, beginning 3 months before wit...
...suggests a daily dose of 5 mg based...
...econception, during pregnancy, and post...
...commends all women with diabetes who are seeki...
...etinopathy is documented, the patient shoul...
...ecommends women with established retinopathy be...
...ES suggests pregnant women with dia...
...preconception and during pregnancy)...
...s all women with diabetes considering pre...
...that a woman with diabetes who has a...
....6b. ES suggests all women with diab...
...ent of Hypertension...
.... ES recommends satisfactory BP control (...
...7b. ES recommends a woman with diabetes who i...
...sts in the exceptional case where the de...
...S recommends when ACE inhibitors or ARBs h...
...evated Vascular Ris...
...recommends that if a woman with d...
...commends if a woman with diabetes is...
...gement of Dyslipidemia...
...S recommends against the use of stat...
...n view of their unproven safety during pr...
...c. ES suggests bile acid-binding resins may be use...
...roid Functio...
...10. For women with type 1 diabetes seekin...
...eight and Obesity...
...nds weight reduction before pregna...
Care During Pregnancy
Care During Pr...
...vert Diabetes in Early Pregnancy...
...ends universal testing for diabetes (see Table 1...
Testing for Gestational Diabetes at 24-2...
...mmends pregnant women not previously ide...
...nds that gestational diabetes be diagnosed with...
...1. Diagnostic Criteria for Overt Diab...
...nostic Criteria for Overt Diabetes and Gestation...
...ent of Elevated Blood Glucos...
...mends women with gestational diabetes target...
...ends the initial treatment of gesta...
...ends using blood glucose-lowering ph...
...0 Glucose Monitoring and Glycemic...
...itoring of Blood Glucose...
.... ES recommends self-monitoring of blood...
...uggests testing before and either 1 or 2 hours aft...
...lycemic Targets (T...
...a. ES recommends pregnant women with over...
...other meals)700...
...s that an even lower fasting blood gluco...
3.2c. ES suggests pregnant women with overt or...
...2d. ES suggests pregnant women with overt diabet...
...ntinuous Glucose Monitoring...
.... ES suggests that continuous glucose mo...
...3. Preconception Glycemic Targets for...
...ition Therapy and Weight Gain Targets...
...trition Therapy...
...nds MNT for all pregnant women with overt...
...t Management...
4.2a. ES suggests women with overt o...
...2b. ES suggests obese women with overt o...
Carbohydrate I...
4.3. ES suggests women with overt or g...
...able 4. 2009 IOM Recommendations for...
...ional Supplements...
.... ES recommends pregnant women with overt or ges...
...gests the dose of folic acid be reduced to 0...
.... Blood Glucose-Lowering Pharmacological The...
...lin Therapy...
...suggests the long-acting insulin analog d...
...ests those pregnant women successfully us...
...ES suggests the rapid-acting insulin...
...recommends the ongoing use of continuous SC insul...
...ggests that continuous SC insulin infusion...
...lin Antihyperglycemic Agent Therapy...
...suggests glyburide (glibenclamide) is...
...sts metformin therapy be used for glyc...
Intra- and Postpartum Care
...nd Postpartum Care...
..., Delivery, Lactation, and Postpartum Car...
...cose Targets During Labor and Delivery...
...s target blood glucose levels of 72-126 mg/dL (4.0...
Lactat...
...ends women with overt or gestational...
...ES recommends women with overt diabetes who are b...
...tum Contraception...
...mmends the choice of a contraceptive method for...
...for Postpartum Thyroiditis...
...uggests women with type 1 diabetes...
...partum Care...
...recommends postpartum care for women who have...
...4b. ES recommends a 2-hour, 75-g OGTT should be un...
...lts are normal, we recommend this or other di...
...uggests the child’s birth weight...
...mends all women who have had gestation...
.... ES suggests blood glucose-lowering medication s...