- 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.
- 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.
- Literature review, expert commentary.
- Funding: None disclosed.
- Recommendations may change with new research.