Management of Diabetes in Pregnancy: Difference between revisions
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{{CMG}} {{AE}} {{SCh | {{CMG}} {{AE}} {{SCh}}; {{TarekNafee}} | ||
==2016 ADA Standards of Medical Care in Diabetes Guidelines== | ==2016 ADA Standards of Medical Care in Diabetes Guidelines<ref name="urlcare.diabetesjournals.org">{{cite web |url=http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf |title=care.diabetesjournals.org |format= |work= |accessdate=}}</ref>== | ||
===PREGESTATIONAL DIABETES=== | |||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Provide preconception counseling that addresses the importance of glycemic control as close to normal as is safely possible, ideally A1C <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Family planning should be discussed and effective contraception should be prescribed and used until a woman is prepared and ready to become pregnant. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Women with preexisting type 1 or type 2 diabetes who are planning pregnancy or who have become pregnant should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur before pregnancy or in the first trimester and then be monitored every trimester and for 1 year postpartum as indicated by degree of retinopathy. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>''' | |} | ||
===GESTATIONAL DIABETES MELLITUS=== | |||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Lifestyle change is an essential component of management of gestational di- abetes mellitus and may suffice for treatment for many women. Medications should be added if needed to achieve glycemic targets ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Preferred medications in gestational diabetes mellitus are insulin and metformin; glyburide may be used but may have a higher rate of neonatal hypoglycemia and macrosomia than insulin or metformin. Other agents have not been adequately studied. Most oral agents cross the placenta, and all lack long-term safety data. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
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|} | |||
===GENERAL PRINCIPLES FOR MANAGEMENT OF DIABETES IN PREGNANCY=== | |||
{|class="wikitable" | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reli- able contraception. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Fasting, preprandial, and postprandial self-monitoring of blood glucose are recommended in both gestational diabetes mellitus and pregestational diabe- tes in pregnancy to achieve glycemic control ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Due to increased red blood cell turnover, A1C is lower in normal pregnancy than in normal nonpregnant women. The A1C target in pregnancy is 6–6.5% (42–48 mmol/mol); <6% (42 mmol/mol) may be optimal if this can be achieved without significant hypoglycemia, but the target may be relaxed to <7% (53 mmol/mol) if necessary to prevent hypoglycemia. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
|} | |} | ||
Latest revision as of 20:41, 12 December 2016
|
2016 ADA Guideline Recommendations |
|
Types of Diabetes Mellitus |
|---|
|
2016 ADA Standard of Medical Care Guideline Recommendations |
|
Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]
2016 ADA Standards of Medical Care in Diabetes Guidelines[1]
PREGESTATIONAL DIABETES
| "1. Provide preconception counseling that addresses the importance of glycemic control as close to normal as is safely possible, ideally A1C <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies. (Level of Evidence: B)" |
| "2. Family planning should be discussed and effective contraception should be prescribed and used until a woman is prepared and ready to become pregnant. (Level of Evidence: A)" |
| "3. Women with preexisting type 1 or type 2 diabetes who are planning pregnancy or who have become pregnant should be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examinations should occur before pregnancy or in the first trimester and then be monitored every trimester and for 1 year postpartum as indicated by degree of retinopathy. (Level of Evidence: B)" |
GESTATIONAL DIABETES MELLITUS
| "1. Lifestyle change is an essential component of management of gestational di- abetes mellitus and may suffice for treatment for many women. Medications should be added if needed to achieve glycemic targets (Level of Evidence: A)" |
| "2. Preferred medications in gestational diabetes mellitus are insulin and metformin; glyburide may be used but may have a higher rate of neonatal hypoglycemia and macrosomia than insulin or metformin. Other agents have not been adequately studied. Most oral agents cross the placenta, and all lack long-term safety data. (Level of Evidence: A)" |
GENERAL PRINCIPLES FOR MANAGEMENT OF DIABETES IN PREGNANCY
| "1. Potentially teratogenic medications (ACE inhibitors, statins, etc.) should be avoided in sexually active women of childbearing age who are not using reli- able contraception. (Level of Evidence: B)" |
| "2. Fasting, preprandial, and postprandial self-monitoring of blood glucose are recommended in both gestational diabetes mellitus and pregestational diabe- tes in pregnancy to achieve glycemic control (Level of Evidence: B)" |
| "3. Due to increased red blood cell turnover, A1C is lower in normal pregnancy than in normal nonpregnant women. The A1C target in pregnancy is 6–6.5% (42–48 mmol/mol); <6% (42 mmol/mol) may be optimal if this can be achieved without significant hypoglycemia, but the target may be relaxed to <7% (53 mmol/mol) if necessary to prevent hypoglycemia. (Level of Evidence: B)" |
Refrences
- ↑ "care.diabetesjournals.org" (PDF).