B. The OGTT is more sensitive at detecting glucose intolerance, including both prediabetes and diabetes. There are no adequate data on optimal weight gain versus weight maintenance in women with BMI >35 kg/m2. The American Diabetes Association (ADA) is the nation's leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. Glyburide was associated with a higher rate of neonatal hypoglycemia and macrosomia than insulin or metformin in a 2015 meta-analysis and systematic review (65). 2451 Crystal Drive,Suite 900 Gestational diabetes mellitus: Glucose management and - UpToDate E, 15.28 Postpartum care should include psychosocial assessment and support for self-care. ADA Releases 2021 Standards of Medical Care in Diabetes Centered on American Diabetes Association; 14. Counseling on diabetes in pregnancy per current standards, including: natural history of insulin resistance in pregnancy and postpartum; preconception glycemic targets; avoidance of DKA/severe hyperglycemia; avoidance of severe hypoglycemia; progression of retinopathy; PCOS (if applicable); fertility in patients with diabetes; genetics of diabetes; risks to pregnancy including miscarriage, still birth, congenital malformations, macrosomia, preterm labor and delivery, hypertensive disorders in pregnancy, etc. There was no difference in pregnancy loss, neonatal care, or other neonatal outcomes between the groups with tighter versus less tight control of hypertension (116). For 82 years, the ADA has driven discovery and research to treat, manage, and prevent diabetes while working relentlessly for a cure. The current recommended amount of carbohydrate is 175 g, or 35% of a 2,000-calorie diet. The committee is a multidisciplinary team of 16 leading U.S. experts in the field of diabetes care and includes physicians, diabetes care and education specialists, registered dietitians, and others with experience in adult and pediatric endocrinology, epidemiology, public health, cardiovascular risk management, microvascular complications, preconception and pregnancy care, weight management and diabetes prevention, and use of technology in diabetes management. However, due to the potential for growth restriction or acidosis in the setting of placental insufficiency, metformin should not be used in women with hypertension or preeclampsia or at risk for intrauterine growth restriction (88,89). A Insulin is the preferred agent for the management of type 2 diabetes in pregnancy. Lower limits are based on the mean of normal blood glucose in pregnancy (36). The A1C target in a given patient should be achieved without hypoglycemia, which, in addition to the usual adverse sequelae, may increase the risk of low birth weight (45). Women with GDM have a 10-fold increased risk of developing type 2 diabetes compared with women without GDM (119). Gestational diabetes can be a scary diagnosis, but like other forms of diabetes, it's one that you can manage. This difference was not found in the Adelaide cohort. There was heterogeneity in the types of effective exercise (aerobic, resistance, or both) and duration of exercise (2050 min/day, 27 days/week of moderate intensity) (65). Metformin was associated with a lower risk of neonatal hypoglycemia and less maternal weight gain than insulin in systematic reviews (65,6769). Ideally, the A1C target in pregnancy is <6% (42 mmol/mol) if this can be achieved without significant hypoglycemia, but the target may be relaxed to <7% (53 mmol/mol) if necessary to prevent hypoglycemia. 15.4 Women with preexisting diabetes who are planning a pregnancy should ideally be managed beginning in preconception in a multidisciplinary clinic including an endocrinologist, maternal-fetal medicine specialist, registered dietitian nutritionist, and diabetes care and education specialist, when available. During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. Planning pregnancy is critical in women with preexisting diabetes due to the need for preconception glycemic control to prevent congenital malformations and reduce the risk of other complications. Recommended weight gain during pregnancy for women with overweight is 1525 lb and for women with obesity is 1020 lb (58). Although observational studies are confounded by the association between elevated periconceptional A1C and other poor self-care behavior, the quantity and consistency of data are convincing and support the recommendation to optimize glycemia prior to conception, given that organogenesis occurs primarily at 58 weeks of gestation, with an A1C <6.5% (48 mmol/mol) being associated with the lowest risk of congenital anomalies, preeclampsia, and preterm birth (37). The OGTT is more sensitive at detecting glucose intolerance, including both prediabetes and diabetes. Absolute risk increases linearly through a womans lifetime, being approximately 20% at 10 years, 30% at 20 years, 40% at 30 years, 50% at 40 years, and 60% at 50 years (108). Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. Members of the ADA P A, 14.23 Screen women with a recent history of gestational diabetes mellitus at 412 weeks postpartum, using the 75-g oral glucose tolerance test and clinically appropriate nonpregnancy diagnostic criteria. Some women develop diabetes for the first time during pregnancy. This needs to be individualized for the patient, so discuss the amount needed with your diabetes team. In women taking insulin, particular attention should be directed to hypoglycemia prevention in the setting of breastfeeding and erratic sleep and eating schedules (126). However, a meta-analysis and an additional trial demonstrate that low-dose aspirin <100 mg is not effective in reducing preeclampsia. C. The physiology of pregnancy necessitates frequent titration of insulin to match changing requirements and underscores the importance of daily and frequent self-monitoring of blood glucose. American Diabetes Association Professional Practice Committee; 15. Gestational diabetes - Diagnosis and treatment - Mayo Clinic This usually results in a doubling of daily insulin dose compared with the prepregnancy requirement. More than 122 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease.
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