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 of Women with Diabetes...
...The Endocrine Society (ES) recommends pre...
...ion Glycemic Control...
...uggests women with diabetes seeking...
...lin Therapy...
...ES recommends insulin-treated women with dia...
...s a change to a woman’s insulin regimen, par...
....3c. ES suggests insulin-treated wome...
...ggests women with diabetes successf...
...Acid Supplementation...
...ommends, beginning 3 months before withdrawing...
...ggests a daily dose of 5 mg based on...
...lar Care (preconception, during pregnancy,...
...nds all women with diabetes who are seeking...
...retinopathy is documented, the patient shoul...
...nds women with established retinopathy be seen b...
...sts pregnant women with diabetes not kn...
...tion (preconception and during pregnancy)...
...ggests all women with diabetes considering...
...ggests that a woman with diabetes who has a...
...sts all women with diabetes and preconcepti...
...anagement of Hyperte...
.... ES recommends satisfactory BP control...
.... ES recommends a woman with diabetes who i...
...ES suggests in the exceptional ca...
....7d. ES recommends when ACE inhibito...
...ted Vascular Ris...
...ES recommends that if a woman with diabetes has...
...mends if a woman with diabetes is s...
...anagement of Dyslipidem...
...ES recommends against the use of statins...
.... In view of their unproven safety during p...
...S suggests bile acid-binding resins may be used...
Thyroid Functi...
...en with type 1 diabetes seeking conc...
...erweight and Obesity...
...1. ES recommends weight reduction before pregnan...
Care During Pregnancy
...e During Pregnanc...
...for Overt Diabetes in Early Pregnancy...
...mmends universal testing for diabetes (see Tabl...
...g for Gestational Diabetes at 24-28 Weeks G...
...2. ES recommends pregnant women not previously...
...that gestational diabetes be diagnosed...
.... Diagnostic Criteria for Overt Dia...
...able 2. Diagnostic Criteria for Overt D...
...gement of Elevated Blood...
...recommends women with gestational diabet...
...ends the initial treatment of gestat...
...nds using blood glucose-lowering pharmacol...
...ose Monitoring and Glycemic Ta...
...onitoring of Blood Glu...
....1. ES recommends self-monitoring of bl...
...gests testing before and either 1 or 2 hou...
...emic Targets (Table 3)...
...recommends pregnant women with over...
...r other meals)700
...uggests that an even lower fasting blood glucos...
...s pregnant women with overt or gestational diabe...
...d. ES suggests pregnant women with over...
...tinuous Glucose Monitorin...
.... ES suggests that continuous glucose moni...
...e 3. Preconception Glycemic Targets for Women Wi...
...n Therapy and Weight Gain Targets for Women With O...
...tion Therapy...
...nds MNT for all pregnant women with overt or ge...
...ight Management...
.... ES suggests women with overt or gestatio...
...b. ES suggests obese women with overt or gest...
...ohydrate Intake...
...3. ES suggests women with overt or gest...
...M Recommendations for Total Weight...
...onal Supplements...
...commends pregnant women with overt or...
...suggests the dose of folic acid be reduced to 0...
...ucose-Lowering Pharmacological Ther...
...sulin Therapy...
...1a. ES suggests the long-acting insuli...
...suggests those pregnant women successfully...
....1c. ES suggests the rapid-acting insulin anal...
...ends the ongoing use of continuous S...
...that continuous SC insulin infusion NOT be init...
...n Antihyperglycemic Agent Ther...
...ests glyburide (glibenclamide) is a suit...
...2b. ES suggests metformin therapy be used f...
Intra- and Postpartum Care
Intra- and Postpartu...
...ery, Lactation, and Postpartum Care...
...lood Glucose Targets During Labor...
....1. ES suggests target blood glucose...
...tation...
...ends women with overt or gestational di...
...ends women with overt diabetes who are breastfeed...
...tpartum Contraception
...ES recommends the choice of a contraceptive met...
...reening for Postpartum Thyroidi...
...suggests women with type 1 diabetes be screened...
...tpartum Care...
.... ES recommends postpartum care fo...
...mmends a 2-hour, 75-g OGTT should be un...
...ults are normal, we recommend this or othe...
...S suggests the child’s birth weight and...
...mmends all women who have had gestational di...
...suggests blood glucose-lowering medicati...