ACOG Practice Bulletin: guidelines released for pregestational DM

  • Obstet Gynecol
  • 1 Dec 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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  • The American College of Obstetricians and Gynecologists (ACOG) has released practice guidelines for management of pregestational diabetes mellitus (DM) during pregnancy.

Why this matters

  • An estimated 14.9 million US women have diabetes.
  • 1%-2% of pregnancies are complicated by pregestational diabetes, in part because of co-occurring obesity.
  • Pregestational diabetes during pregnancy is diagnosed by HbA1c ≥6.5%, fasting glucose of ≥126 mg/dL, or 2-hour glucose ≥200 mg/dL on a 75-gram oral glucose tolerance test.

Key recommendations

  • Maternal glucose should be maintained at physiologic levels before and during pregnancy.
  • Carbohydrate counting is important for glucose control.
  • Preconception counseling is beneficial and should include potential complications during pregnancy, evaluation for preexisting diabetic complications, and folic acid supplementation.
  • Timing of delivery:
    • well-controlled blood glucose: 39 weeks 0 days to 39 weeks 6 days;
    • uncontrolled blood glucose: 36 weeks 0 days to 38 weeks 6 days;
    • if estimated fetal weight ≥4500 g, consider elective cesarean delivery.
  • During labor, glucose should be checked hourly to maintain glucose level around 100 mg/dL.
  • Oral hypoglycemic agent use should be limited and individualized.
  • Antepartum surveillance through nonstress tests and biophysical profiles should be used.

Study design

  • Literature review, expert commentary.
  • Funding: None disclosed.


  • Recommendations may change with new research.

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