Pregestational Diabetes Mellitus

Publication Date: November 30, 2018
Last Updated: March 14, 2022

Recommendations

Maternal glucose control should be maintained near physiologic levels before and throughout pregnancy to decrease the likelihood of complications of hyperglycemia, including spontaneous abortion, fetal malformation, fetal macrosomia, fetal death, and neonatal morbidity. (B)
574
The dietary approach to glycemic control is focused on careful carbohydrate counting and allocation of appropriate ratios of carbohydrates to meals and snacks. ( B )
574
Patients and their families should be taught how to respond quickly and appropriately to hypoglycemia. (B)
574
Prepregnancy counseling for women with pregestational diabetes mellitus has been reported to be beneficial and cost effective and should be encouraged. (B)
574
Because pregestational diabetes is considered a highrisk factor for the development of preeclampsia, the American College of Obstetricians and Gynecologists recommends that low-dose aspirin (81 mg/day) prophylaxis should be initiated between 12 weeks and 28 weeks of gestation (optimally before 16 weeks of gestation) and continued until delivery. (B)
574
The use of all oral hypoglycemic agents for control of pregestational type 2 diabetes mellitus during pregnancy should be limited and individualized until data regarding the safety and efficacy of these drugs become available. (B)
574
Insulin is the preferred treatment for pregestational diabetes in pregnancy not controlled by diet and exercise. (B)
574
Antepartum fetal monitoring, including the nonstress test, the biophysical profile, or the modified biophysical profile when performed at appropriate intervals (usually once or twice per week), is a valuable approach and can be used to monitor the pregnancies of women with pregestational diabetes mellitus. (B)
574
Prepregnancy counseling should focus on the importance of euglycemic control before pregnancy, as well as the adverse obstetric and maternal outcomes that can result from poorly controlled diabetes. (C)
574
Although the diagnosis of fetal macrosomia is imprecise, in order to prevent traumatic birth injury to the fetus, prophylactic cesarean delivery may be considered if the estimated fetal weight is at least 4,500 g in women with diabetes. (C)
574

Recommendation Grading

Overview

Title

Pregestational Diabetes Mellitus

Authoring Organization

American College of Obstetricians and Gynecologists

Publication Month/Year

November 30, 2018

Last Updated Month/Year

April 1, 2024

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory

Intended Users

Nurse midwife, nurse, diabetes educator, nurse practitioner, physician, physician assistant

Scope

Counseling, Management

Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus, D016640 - Diabetes, Gestational

Keywords

diabetes mellitus, pregestational