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
...reconception C...
...Care of Women with Diabetes...
...he Endocrine Society (ES) recommends preconce...
...eption Glycemic Contr...
....2. ES suggests women with diabetes s...
...sulin Therapy...
1.3a. ES recommends insulin-treated w...
...gests a change to a woman’s insulin re...
...ests insulin-treated women with diabetes seek...
...gests women with diabetes successfully us...
...c Acid Supplementatio...
...ommends, beginning 3 months before withdrawing con...
...a daily dose of 5 mg based on this dose’...
...ar Care (preconception, during pregnancy, an...
...mmends all women with diabetes who are seeking...
...if retinopathy is documented, the patient sho...
...recommends women with established retinopathy...
...gests pregnant women with diabetes not...
...Function (preconception and during pregnancy)...
...sts all women with diabetes consid...
...that a woman with diabetes who has a...
...6b. ES suggests all women with diabetes...
...agement of Hypertension...
1.7a. ES recommends satisfactory BP con...
...ommends a woman with diabetes who is seeking...
...7c. ES suggests in the exceptional case where...
...ES recommends when ACE inhibitors or ARBs have b...
...levated Vascular Ri...
...S recommends that if a woman with diabete...
...ommends if a woman with diabetes is seeking...
...anagement of Dyslipidemia...
...9a. ES recommends against the use of statins...
...of their unproven safety during pregnancy, ES sugg...
....9c. ES suggests bile acid-binding resins may be...
...oid Function...
...10. For women with type 1 diabetes seeking conc...
...ght and Obesity
...recommends weight reduction before pregna...
Care During Pregnancy
...ring Pregnancy...
...g for Overt Diabetes in Early Pregnan...
...recommends universal testing for diabet...
...esting for Gestational Diabetes at 24...
...nds pregnant women not previously identified (e...
...ds that gestational diabetes be diagnosed wi...
...le 1. Diagnostic Criteria for Overt Diabetes...
...stic Criteria for Overt Diabetes and Gestational D...
...ent of Elevated Blood Glucos...
...recommends women with gestational diabete...
...recommends the initial treatment of...
....3c. ES recommends using blood glucose-lowering p...
...Monitoring and Glycemic Targets...
...nitoring of Blood Glucose...
...S recommends self-monitoring of blood gl...
...nd suggests testing before and either 1 or 2 ho...
...cemic Targets (Table 3...
...mends pregnant women with overt or gestational dia...
(for other meal...
.... ES suggests that an even lower fast...
...S suggests pregnant women with overt...
...2d. ES suggests pregnant women with ov...
Continuous Glucose Mon...
...that continuous glucose monitoring be used during...
...Preconception Glycemic Targets for Wome...
...ion Therapy and Weight Gain Target...
Nutrition Th...
...mmends MNT for all pregnant women with overt or ge...
Weight Management
...sts women with overt or gestational diabe...
...ggests obese women with overt or gestat...
...arbohydrate Intak...
4.3. ES suggests women with overt or gestatio...
...IOM Recommendations for Total Weight Gain and R...
...tritional Supplements...
...ES recommends pregnant women with overt or gesta...
...gests the dose of folic acid be reduced to 0.4-...
...ood Glucose-Lowering Pharmacological Therapy Durin...
...ulin Therap...
...ests the long-acting insulin analog detemir may b...
...ggests those pregnant women successfu...
...gests the rapid-acting insulin analogs lispro and...
...ecommends the ongoing use of contin...
...ut suggests that continuous SC insulin infusion...
...sulin Antihyperglycemic Agen...
...ts glyburide (glibenclamide) is a suitable a...
...s metformin therapy be used for glycemic co...
Intra- and Postpartum Care
Intra- and Postpartum Car...
...Delivery, Lactation, and Postpartum...
...lood Glucose Targets During Labor and Del...
...target blood glucose levels of 72-126 mg/...
...ctation
...commends women with overt or gestational diabet...
...ommends women with overt diabetes who are breastfe...
...um Contraception
...3. ES recommends the choice of a contraceptive...
...eening for Postpartum Thyroi...
...sts women with type 1 diabetes be screened for...
...artum Care...
...ecommends postpartum care for wome...
...ends a 2-hour, 75-g OGTT should be undertaken 6-1...
...s are normal, we recommend this or other dia...
...suggests the child’s birth weight and...
...ends all women who have had gestational diabetes r...
...ts blood glucose-lowering medication s...