Pregnant Women

The annual prevalence of pregestational diabetes is increasing, largely as a result of the obesity epidemic.1

Source: Sugrue R, Zera C. Pregestational Diabetes in Pregnancy. ObstetGynecolClin North Am. 2018;45(2):315-331.

Adverse maternal and fetal consequences of poor glycemic control include2:

  • congenital anomaly
  • miscarriage
  • pre-eclampsia
  • preterm delivery
  • macrosomia
  • stillbirth
  • neonatal hypoglycemia

 

Insulin is the preferred anti-hyperglycemic agent in pregnant women. Insulinrequirements may change during pregnancy.3

ADA-recommended targets for women with Type 1, Type 2 or Gestational Diabetes4

 

○  Fasting: >95mg/dL(5.3mmol/L)andeither

•    One-hourpostprandial,140mg/dL(7.8 mmol/L)or

•    Two-hourpostprandial,120mg/dL(6.7mmol/L)

○  individualized A1C target of >6% (42 mmol/mol)* to >7% (53 mmol/mol)**

*associated with lowest rate of adverse fetal outcomes

** A1C should be used as a secondary measure of glycemic control in pregnancy, after self-monitoring of blood glucose

Source: American Diabetes Association. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S183-S192.

References:

  1. Sugrue R, Zera C. Pregestational Diabetes in Pregnancy. ObstetGynecol Clin North Am. 2018;45(2):315-331.
  2. Etomi O, Banerjee A. The management of pre-existing (type 1 and type 2) diabetes mellitus in pregnancy. Medicine. 2018;46(12):731-737.
  3. O’Neill SM, et al. Different insulin types and regimens for pregnant women with pre-existing diabetes. Cochrane Database Syst Rev. 2017;2:CD011880.
  4. 4. American Diabetes Association. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes — 2020. Diabetes Care.2020;43(Supplement 1):S183-S192.

Resources:

American Diabetes Association. 14. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43 (Supplement 1):S183-S192.
ACOG Practice Bulletin No. 201 Summary: Pregestational Diabetes Mellitus. Obstet Gynecol. 2018;132(6):1514-1516.