diabetics who become pregnant
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Diagnostic procedures
- funduscopic examination by ophthalmologist
- during preconception planning[1]
- each trimester; continue for 1 year postpartum*[1]
* postpartum frequency not specified[1]
Complications
- maternal risks
- pre-eclampsia
- polyhydramnios
- preterm labor
- progression of existing diabetic retinopathy > diabetic nephropathy[9]
- tight glycemic control may increase risk for diabetic retinopathy[1][9]
- fetal risks
- increased risk of major fetal malformations in the 1st 12 weeks of gestation
- intrauterine death
- acute respiratory distress syndrome
- hypoglycemia
- hypocalcemia
- polycythemia
- hyperviscosity
- hyperbilirubinemia
- cardiomyopathy
- macrosomia
- increased risk of early-onset cardiovascular disease in offspring (RR=1.3)[6]
Management
- aggressive control of blood glucose
- HgbA1c < 6.0% is optimal
- continuous glucose monitoring in pregnant women with type 1 diabetes is associated with better neonatal outcomes[5]
- type 2 diabetes
- switch from oral agents to insulin
- metformin & glyburide OK (pregnancy catergory B)*
- metformin appears to be a reasonably safe alternative to insulin for patients who refuse insulin[7]
- sulfonylureas, GLP-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, or flozins not associated with increased risk of birth defects[8]
- use bile acid sequestrant (colesevelam) for treatment of hypercholesterolemia[1]
- statin contraindicated
* oral hypoglycemic agents formerly contraindicated during pregnancy[1][2][3]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018.
- ↑ 2.0 2.1 Prescriber's Letter 7(12):71 2000
- ↑ 3.0 3.1 Prescriber's Letter 14(9): 2007 Treatment of diabetes in women who are pregnant Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230913&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Berghella V, Buchanan E, Pereira L, Baxter JK. Preconception care. Obstet Gynecol Surv. 2010 Feb;65(2):119-31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20100361
- ↑ 5.0 5.1 Feig DS, Donovan LE, Corcoy R et al Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. Sept 15, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28923465 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32400-5/fulltext
- ↑ 6.0 6.1 Yu Y, Arah OA, Liew Z et al Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up. BMJ 2019;367:l6398 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31801789 https://www.bmj.com/content/367/bmj.l6398
- ↑ 7.0 7.1 Boggess KA et al. Metformin plus insulin for preexisting diabetes or gestational diabetes in early pregnancy: The MOMPOD randomized clinical trial. JAMA 2023 Dec 12; 330:2182. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38085312 PMCID: PMC10716718 (available on 2024-06-12) https://jamanetwork.com/journals/jama/fullarticle/2812641
Dunne F et al. Early metformin in gestational diabetes: A randomized clinical trial. JAMA 2023 Oct 24; 330:1547. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37786390 PMCID: PMC10548359 (available on 2024-04-03) https://jamanetwork.com/journals/jama/fullarticle/2810387
Feig DS. Metformin for diabetes in pregnancy: Are we closer to defining its role? JAMA 2023 Dec 12; 330:2167. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38085322 https://jamanetwork.com/journals/jama/fullarticle/2812667 - ↑ 8.0 8.1 Cesta CE et al. Safety of GLP-1 receptor agonists and other second-line antidiabetics in early pregnancy. JAMA Intern Med 2023 Dec 11; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/38079178 PMCID: PMC10714281 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2812743
- ↑ 9.0 9.1 9.2 NEJM Knowledge+
ElSayed NA, Aleppo G, Aroda VR et al 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S254-S266. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36507645 PMCID: PMC9810465 Free PMC article. Review.
Morrison JL, Hodgson LA, Lim LL, Al-Qureshi S. Diabetic retinopathy in pregnancy: a review. Clin Exp Ophthalmol. 2016 May;44(4):321-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27062093 Review. - ↑ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Pregnancy if You Have Diabetes https://www.niddk.nih.gov/health-information/diabetes/diabetes-pregnancy