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
...ption Care of Women with Diabe...
1.1. The Endocrine Society (ES) recommends...
...ion Glycemic Control...
...ES suggests women with diabetes seek...
...n Therapy...
...ES recommends insulin-treated wome...
...3b. ES suggests a change to a woman’s...
...S suggests insulin-treated women with d...
...s women with diabetes successfully using the...
...lic Acid Supplementation
...mmends, beginning 3 months before...
...a daily dose of 5 mg based on this dose’...
...preconception, during pregnancy, and...
...a. ES recommends all women with diabetes who a...
...tinopathy is documented, the patie...
...mends women with established retinopathy be...
...ES suggests pregnant women with diabetes not kn...
...l Function (preconception and duri...
...sts all women with diabetes consideri...
...uggests that a woman with diabetes...
1.6b. ES suggests all women with diab...
...nagement of Hypertension
...commends satisfactory BP contro...
...recommends a woman with diabetes w...
...c. ES suggests in the exceptional case where the...
...mends when ACE inhibitors or ARBs have...
...ted Vascular Ris...
...ends that if a woman with diabetes has sufficie...
1.8b. ES recommends if a woman with d...
...nagement of Dyslipidemi...
...mmends against the use of statins in women with...
...f their unproven safety during pregnancy, ES sugge...
.... ES suggests bile acid-binding resins may b...
...hyroid Function
...For women with type 1 diabetes seeking conceptio...
...ight and Obesit...
...ES recommends weight reduction before pregnancy fo...
Care During Pregnancy
Care During Pregnanc...
...Overt Diabetes in Early Pregnancy...
.... ES recommends universal testing for diabetes...
...Gestational Diabetes at 24-28 Weeks Gestation...
...mmends pregnant women not previously identified...
...that gestational diabetes be diagnosed with t...
...able 1. Diagnostic Criteria for Overt Diabetes an...
.... Diagnostic Criteria for Overt Diabetes a...
...of Elevated Blood Glucose...
...mmends women with gestational diabetes target...
...mmends the initial treatment of gestational diabet...
...S recommends using blood glucose-lowering pharm...
...Monitoring and Glycemic Targets...
...-monitoring of Blood Glucose...
...mmends self-monitoring of blood glucose in al...
...esting before and either 1 or 2 hours a...
...lycemic Targets (Table...
...ES recommends pregnant women with overt or gestati...
(for other mea...
...b. ES suggests that an even lower fa...
...sts pregnant women with overt or gestatio...
....2d. ES suggests pregnant women with overt...
...ous Glucose Monitorin...
...3. ES suggests that continuous glucose moni...
...conception Glycemic Targets for Women...
...herapy and Weight Gain Targets for W...
...rition Therap...
...ecommends MNT for all pregnant women with o...
...ight Management...
.... ES suggests women with overt or ges...
...gests obese women with overt or gestationa...
...rbohydrate In...
...ggests women with overt or gestational diabetes l...
...4. 2009 IOM Recommendations for Total Weight G...
...itional Supplements
...mends pregnant women with overt or gestational d...
...suggests the dose of folic acid be r...
...Blood Glucose-Lowering Pharmacological The...
...nsulin Ther...
....1a. ES suggests the long-acting insulin an...
...1b. ES suggests those pregnant women successfully...
...gests the rapid-acting insulin analog...
...ES recommends the ongoing use of continuous SC ins...
...suggests that continuous SC insuli...
...ntihyperglycemic Agent Therapy...
...ES suggests glyburide (glibenclamide) is a s...
...b. ES suggests metformin therapy be used for...
Intra- and Postpartum Care
...a- and Postpartum Ca...
....0 Labor, Delivery, Lactation, and P...
...Glucose Targets During Labor and Delivery...
...ests target blood glucose levels of...
Lactat...
...ecommends women with overt or gestational...
...recommends women with overt diabetes who are bre...
...stpartum Contrace...
...ends the choice of a contraceptive method for a w...
Screening for Postpartum Thyroiditis
...uggests women with type 1 diabetes be s...
Postpartum...
...ends postpartum care for women who have had g...
...ommends a 2-hour, 75-g OGTT should be underta...
If results are normal, we recommend this or...
...ts the child’s birth weight and whether...
...ends all women who have had gestational dia...
...4e. ES suggests blood glucose-lowering medicat...