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
...Preconception Care...
...Preconception Care...
...ocrine Society (ES) recommends preconception cou...
...Preconception Glyce...
...S suggests women with diabetes seeking to conceiv...
...Insulin Therapy...
....3a. ES recommends insulin-treated women with di...
...ests a change to a woman’s insulin regimen, pa...
...ES suggests insulin-treated women with diabetes s...
...ggests women with diabetes successfully...
...Folic...
...nds, beginning 3 months before withdrawing contra...
...s a daily dose of 5 mg based on this dos...
...Ocular...
...ecommends all women with diabetes who are se...
...etinopathy is documented, the patient shoul...
...commends women with established retinop...
.... ES suggests pregnant women with di...
...Renal Function...
...uggests all women with diabetes considering pregn...
...ests that a woman with diabetes who has a si...
....6b. ES suggests all women with di...
...Management of Hype...
...ES recommends satisfactory BP control...
...mends a woman with diabetes who is seeki...
...ES suggests in the exceptional case where the d...
...S recommends when ACE inhibitors or...
...Elevated Vascula...
...ecommends that if a woman with dia...
...nds if a woman with diabetes is seeking pregna...
...Manage...
....9a. ES recommends against the use of statins in w...
...w of their unproven safety during p...
.... ES suggests bile acid-binding resins may b...
...Thyro...
...men with type 1 diabetes seeking con...
...Overweight...
1.11. ES recommends weight reduction befo...
Care During Pregnancy
...Care During Pre...
...Testin...
...ends universal testing for diabetes (se...
...Testing f...
...ommends pregnant women not previously identifie...
...ecommends that gestational diabetes be diagnos...
...iagnostic Criteria for Overt Diabetes an...
...2. Diagnostic Criteria for Overt Diabetes and Ge...
...Management of Elevate...
...recommends women with gestational diabetes tar...
...ecommends the initial treatment of g...
2.3c. ES recommends using blood glu...
...3.0 Glucose...
...Self-m...
...ecommends self-monitoring of blood glucose in...
...sts testing before and either 1 or 2...
...Glycemic Targets (T...
...commends pregnant women with overt or gesta...
(for other meals)7...
...suggests that an even lower fasting bl...
...ts pregnant women with overt or gestatio...
...gests pregnant women with overt diabetes...
...C...
...ES suggests that continuous glucose mon...
...nception Glycemic Targets for Women Wi...
...4.0. Nutrition Therap...
...recommends MNT for all pregnant women with overt...
...Wei...
...sts women with overt or gestational diabetes fol...
...ts obese women with overt or gestational diabetes...
...Carboh...
...suggests women with overt or gesta...
.... 2009 IOM Recommendations for Total Weig...
...Nutritional S...
...ecommends pregnant women with overt or gestational...
...uggests the dose of folic acid be reduced t...
...5.0....
...Insulin Ther...
...suggests the long-acting insulin analo...
...S suggests those pregnant women success...
...ests the rapid-acting insulin analogs lispro and...
...ommends the ongoing use of continuous SC in...
...uggests that continuous SC insulin infusion NOT b...
...Noninsulin Antihypergl...
...s glyburide (glibenclamide) is a suitable al...
...ts metformin therapy be used for glyc...
Intra- and Postpartum Care
...Intra- a...
...6.0 Labor...
...Blood...
...ggests target blood glucose levels...
...La...
...ES recommends women with overt or gestational diab...
...S recommends women with overt diabetes who are bre...
...Pos...
.... ES recommends the choice of a contraceptive m...
...Screening for Postpar...
...uggests women with type 1 diabetes...
...Postpar...
...ommends postpartum care for women who...
...recommends a 2-hour, 75-g OGTT should be underta...
If results are normal, we recommend th...
...ES suggests the child’s birth weight and whet...
...ommends all women who have had gesta...
....4e. ES suggests blood glucose-lowering...