Pregestational diabetes acog .pdf download

Furthermore, a multiple time series expected that women with GDM who have poor glyce- cohort study showed that there were no significant mic control also would be at increased risk.

Additionally, in women whose when compared with expectantly managed historic con- fetuses received an LGA diagnosis, the risk of cesar- trols It has been estimated that up to cesarean 40 weeks of gestation versus 1. A systemat- permanent brachial plexus palsy for an estimated fetal ic review later confirmed these findings However, weight of 4, g, and up to cesarean deliveries a recent study that compared induction of labor before would be needed for an estimated fetal weight of 4, g 40 weeks of gestation with expectant management dem- , Based on the available data, it is not possible onstrated a reduction in cesarean delivery among women to determine whether the potential benefits of planned with GDM who were induced A decision analysis cesarean delivery at a given estimated fetal weight are demonstrated that delivery of women with GDM at similar for women with GDM and women with pre- 38 weeks or 39 weeks of gestation would reduce overall existing diabetes.

Therefore, it appears reasonable to perinatal mortality without increasing cesarean delivery recommend that women with GDM should be counseled rates Although persuasive, these data have not regarding the risks and benefits of a scheduled cesarean been confirmed by large randomized trials. Therefore, delivery when the estimated fetal weight is 4, g or the timing of delivery in women with GDM that is more But clear guidance about the degree of glycemic tes predominantly type 2 later in life 8, — In light of this, consideration type 2 diabetes compared with women without a history of timing should incorporate tradeoffs between the risks of GDM Therefore, screening at 4—12 weeks post- of prematurity and the ongoing risks of stillbirth.

A fasting plasma glucose test and the g, 2-hour gestation should be reserved for those women who fail OGTT have been used for diagnosing overt diabetes in-hospital attempts to improve glycemic control or who in the postpartum period. Although the fasting plasma have abnormal antepartum fetal testing.

Therefore, complicated by diabetes than in pregnancies not compli- the Fifth International Workshop on Gestational Diabetes cated by diabetes 97—99 , it is reasonable for clinicians Mellitus recommends that women with GDM undergo a to assess fetal growth by ultrasonography or by clinical g, 2-hour OGTT in the postpartum period This examination late in the third trimester to attempt to iden- usually should include a fasting plasma glucose as well.

However, All women who had GDM should follow up with data are insufficient to determine whether cesarean a primary care physician. Additionally, women with delivery should be performed to reduce the risk of birth impaired fasting glucose, IGT, or diabetes should be trauma in cases of suspected macrosomia. Although referred for preventive or medical therapy. Women with frank diabetes VOL.

Management of postpartum screening results. The The following recommendations and conclusions ADA and ACOG recommend repeat testing every are based on limited or inconsistent scientific 1—3 years for women who had a pregnancy affected by evidence Level B : GDM and normal postpartum screening test results For women who may have subsequent pregnan- All pregnant women should be screened for GDM cies, screening more frequently between pregnancies with a laboratory-based screening test s using can detect abnormal glucose metabolism before fer- blood glucose levels.

Women should be obstetricians or other obstetric care providers encouraged to discuss their GDM history and need believe will be unable to safely administer insulin, for screening with their obstetricians or obstetric care or for women who cannot afford insulin, metformin providers.

Glyburide treatment should not be recommended as Summary of a first-choice pharmacologic treatment because, in Recommendations and most studies, it does not yield equivalent outcomes to insulin. Conclusions Health care providers should counsel women of the The following recommendations and conclusions limitations in safety data when prescribing oral are based on good and consistent scientific agents to women with GDM.

When pharmacologic treatment of GDM is indicat- The following recommendations and conclusions ed, insulin is considered the preferred treatment for are based primarily on consensus and expert diabetes in pregnancy. You alence rates of GDM when making their decision. In the absence of clear comparative trials, one set of These resources are for information only and are not diagnostic criteria for the 3-hour OGTT cannot be meant to be comprehensive.

Referral to these resources clearly recommended over the other. Trends in prevalence of diabetes among delivery hos- dietary counseling , surveillance of blood glucose pitalizations, United States, Matern Child levels is required to confirm that glycemic control Health J ; Am J Obstet recommended to distribute carbohydrate intake and Gynecol ; Low-educated women have an increased risk of gestational diabetes mellitus: the moderate-intensity aerobic exercise at least 5 days a Generation R Study.

Acta Diabetol ;— The association controlled with only diet and exercise A1GDM between preeclampsia and the severity of gestational should not be before 39 weeks of gestation, unless diabetes: the impact of glycemic control. Am J Obstet Gynecol ;— The influence of obesity and diabetes on the risk setting of indicated antepartum testing is general- of cesarean delivery. Am J Obstet Gynecol ; ly appropriate.

Am J Obstet Gynecol Screening at 4—12 weeks postpartum is recommend- ; Body weight and subsequent diabetes with diabetes, impaired fasting glucose levels, or mellitus. JAMA ;— Women with impaired 8. Gestational diabetes fasting glucose, IGT, or diabetes should be referred and the incidence of type 2 diabetes: a systematic review.

Predicting future diabetes in Latino and normal postpartum screening test results. Utility of early post- partum glucose tolerance testing. Diabetes ; Women with GDM should be counseled regarding — The risk of stillbirth and more. Am J Obstet Gynecol ; Screening for e1—7.

Am J Obstet Gynecol ;—4. Chaovarindr U, Coustan DR, et al. N Engl J Med ;— Psychological stress associated diabetes conveys risks for type 2 diabetes and obesity: a with diabetes during pregnancy: a pilot study. Ir Med J study of discordant sibships. Diabetes ;— Overweight and the a study in diabetic patients. Qual Life Res ;—8. J Clin Endocrinol Metab ;— Diabetes Care patients.

Carpenter- Management of diabetes mellitus by obstetri- data group thresholds for gestational diabetes mellitus. Moyer VA. International Association U. Preventive Services Task Force. Ann tions on the diagnosis and classification of hyperglyce- Intern Med ;— International Association of Diabetes Maternal age and screening for Care ;— Obstet Standards of medical care in diabetes— American Gynecol ;— Diabetes Care ;34 suppl 1 : Universal versus selective gestational dia- Effects of treatment in women with Association recommendations.

Am J Obstet Gynecol gestational diabetes mellitus: systematic review and ;— BMJ ;c Management of diabetes in pregnancy. American Different Diabetes Association.

Diabetes Care ;S—9. Cochrane Database of Classification and diagnosis of diabetes. American Systematic Reviews , Issue 1. Diabetes Association. Diabetes Care ;S11— Effect of treatment of gestational Neuman A. Diagnosis and management of diabetes: diabetes mellitus on pregnancy outcomes.

N Engl J Med ; ;— A multicenter, randomized women at high risk for gestational diabetes. Acta Obstet trial of treatment for mild gestational diabetes. Eunice Gynecol Scand ;—7. NIH consensus devel- Network. Benefits and harms of treat- 1— Preventive Services Ann Intern Med diabetes. Clin Perinatol ;— Women with Crowther CA.

Different types of dietary advice for gestational diabetes mellitus randomized to a higher- women with gestational diabetes mellitus.

Diabetes Care ;— Can a low-glycemic index diet reduce the need for A randomized Randomized trial of diet versus diet plus cardiovascular trial. Diabetes Care ;— Am J Obstet Gynecol ;—9. A randomized controlled trial investigat- Therapeutic exercise for insulin-requiring outcomes in gestational diabetes mellitus. Diabetes Care gestational diabetics: effects on the fetus—results of a ;—6. J Perinat Med ;— Exercise for diabetic pregnant women.

Cochrane Database of Sys- Home- tematic Reviews , Issue 3. Med Sci Sports Exerc ;—9. Exercise during pregnancy and gestational diabetes- Br Unnikrishnan R, Bhavadharini B, et al. Physical activ- J Sports Med ;—6. Diabetes Res Clin Pract ;— Glycemic characteristics and neo- natal outcomes of women treated for mild gestational Appl Physiol Nutr Metab ;—7.

Agency for Healthcare Research and Quality. Postprandial versus preprandial blood management, delivery, and postpartum risk assessment glucose monitoring in women with gestational diabe- and screening in gestational diabetes. Rockville MD : ;— Randomized controlled cose measurement in gestational diabetes: a prospective trial of insulin detemir versus NPH for the treatment of study.

J Perinatol ;—4. Gestational diabetes mellitus. At what time should the postprandial glu- Physicians should claim only the credit commensurate with the extent of their participation in the activity. The maximum number of hours awarded for this Continuing Nursing Education activity is 0. ACOG addresses the management of pregnant women with pregestational diabetes, including specific guidance for the multiple aspects of care. Judicious use of operative vaginal delivery is reasonable even in the presence of risk factors for shoulder dystocia.

Insulin resistance increases during pregnancy to its highest level in the 3 rd trimester, except for late 1 st trimester when high levels of estrogen enhance insulin sensitivity and increase risk of maternal hypoglycemia.

Maternal mortality from DKA is rare, and fetal mortality has decreased substantially in recent years. Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners.

Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management.

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