Pregnancy

Updated: 8.5.2008

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PIER > Diabetes in Pregnancy > Prevention

Counsel all diabetic women of childbearing potential on the need for pregnancy planning.

Counsel all obese women of childbearing age on the need for diet and exercise to decrease the risk of gestational diabetes.

Stop ACE inhibitor therapy, switch oral hypoglycemics to insulin, and review all other medications before conception.

PIER > Diabetes in Pregnancy > Diagnosis

History and Physical Examination
Evaluate women with pregestational diabetes for diabetic complications before conception and review issues of diabetic control, and review symptoms of hyperglycemia in all pregnant women.

Laboratory Tests
Use laboratory testing to evaluate diabetic control and to screen for related medical conditions.

Differential Diagnosis
Not applicable to this module.

PIER > Diabetes in Pregnancy > Hospitalization

Hospitalize pregnant women with elevated glucose levels and poor outpatient control.

Hospitalize pregnant women with evidence of ketoacidosis.

PIER > Diabetes in Pregnancy > Non-drug Therapy

Stress diet and exercise in pregnant diabetic patients to control glucose levels.

Continue foot care in women with pregestational diabetes.

Recommend smoking cessation in all women with diabetic pregnancies.

PIER > Diabetes in Pregnancy > Drug Therapy

Use insulin in patients with gestational diabetes to achieve optimal glycemic control.

Switch all women with pregestational diabetes on oral diabetic treatments to insulin before conception.

Stop ACE inhibitor therapy and review the patient's other medications before conception.

PIER > Diabetes in Pregnancy > Consultation for Management

Ensure specialized obstetric care for diabetic women who are pregnant or planning pregnancies.

Consider consultation with an endocrinologist and other professionals to ensure ideal glucose levels before and during pregnancy in diabetic women.

Obtain specialty consultation for help in managing complications of diabetes in pregnant women or before conception.

PIER > Diabetes in Pregnancy > Follow-up

Review blood glucose logs at every visit and adjust insulin accordingly.

Review diabetes drugs after delivery and make changes as necessary.

Screen women with pregestational diabetes for the development or worsening of diabetic complications during pregnancy.

Plan future pregnancies postpartum.

After delivery, classify patients found to be diabetic during pregnancy and arrange for long-term follow-up.

ACP Diabetes Care Guide > Diabetes in Women of Childbearing Age

From the ACP Diabetes Care Guide

Topics in this chapter include:

Planning for Pregnancy
Glycemic Goals
Management of Diabetes Before and During Pregnancy
Complications of Diabetes During Pregnancy

NOTE: You may order free copies of the complete ACP Diabetes Care Guide (book and CD-ROM).

open document (pdf)

ACP Internist Weekly - August 5, 2008 - Diabetes increases birth defect risk

Women who have been diagnosed with diabetes before pregnancy are more likely to have a child with birth defects, according to a new national study.

The multi-center, case-control study included mothers of 13,000 infants who were born with birth defects and 4,900 who were born without. Data from nine states were gathered for this largest-ever study of birth defects in the U.S. Researchers compared the rates of individual and multiple defects in women with pre-gestational diabetes, gestational diabetes and no diabetes. Women with pre-pregnancy type 1 or type 2 diabetes were three times more likely than nondiabetic women to have infants with one birth defect and eight times more likely to be the mothers of children with multiple defects.