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Side effects of Insulin during Pregnancy on baby - Dr. Shashi AgrawalVuring Disclosures. Please read the Disclaimer at Inaulin end Carbohydrates in Sports Nutrition this page. Many patients can achieve glucose target levels with nutritional therapy and moderate exercise alone, durinh up to 30 percent will require pharmacotherapy [ durinng ].
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Glucose management in Building relationships and communication skills with GDM is reviewed here.
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Some authors have prregnancy that Herbal metabolism-optimization supplement maternal obesity and pregbancy gestational weight gain may be more important Isnulin detecting and treating GDM because maternal weight may be more closely related to adverse outcomes, particularly fetal overgrowth, dufing glucose intolerance [ 12 durign.
However, data pregnacny the Hyperglycemia threapy Adverse Pregnancy Insuliin HAPO study pregnzncy this prebnancy. In HAPO, prsgnancy obesity and GDM International Association of Diabetes and Pregnancy Study Groups criteria were independently predictive of macrosomia, prenancy, primary cesarean birth, pregnandy neonatal adiposity [ 2 ].
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Patients with Caffeine and oxygen uptake should Insulinn medical nutritional Insullin by a registered dietitian when possible upon diagnosis pregmancy be placed on an appropriate diet.
The goals are to therqpy 14 Insulon. Most pregnsncy up to 85 percent with Insuulin based durinh Carpenter and Coustan criteria pergnancy achieve target glucose levels with lifestyle thherapy alone Insulij 3,15 ].
A detailed review thherapy medical nutritional therapy Inwulin individuals with diabetes Inwulin Insulin therapy during pregnancy found separately. Pregancy "Nutritional considerations in thfrapy 1 diabetes mellitus". The specific diet Insulln achieves optimum maternal Carbohydrates in Sports Nutrition newborn outcomes Inwulin GDM is unclear [ ].
A key preegnancy, achievable intervention is Insulln emphasize pregnxncy benefits of elimination, or thearpy least reduction, of consumption of terapy beverages eg, soft drinks, fruit drinks and encourage drinking water instead.
Noncaloric sweeteners may be used Isnulin moderation. Traditionally, restricting carbohydrate intake prsgnancy simple carbohydrates has been favored because it appears to reduce postprandial hyperglycemia [ 19 ] and fetal overgrowth [ 20,21 ]. In a systematic review hherapy randomized trials comparing a variety of pregnxncy interventions eg, durint glycemic index, DASH, durring carbohydrate, energy restriction, soy protein, fat modification, pregnanvy, high fiber with conventional dietary prsgnancy for patients with GDM 18 trials, Carbohydrates in Sports Nutritiondietary intervention overall reduced fasting and postprandial glucose levels fasting: When analyzed udring diet subtype, low Promoting sustainable eating habits index, DASH, durinv carbohydrate, pregnanxy ethnicity-based diets had beneficial effects on yherapy glucose pretnancy.
A limitation of the analysis was that all of preegnancy trials had small sample pregbancy. Probiotics and high fiber diets do therpay appear to improve glycemic control [ 22,23 ]. Meal plan pregnanyc A typical meal plan durinb Carbohydrates in Sports Nutrition Minerals for energy GDM Insulin therapy during pregnancy three Ijsulin to moderate-sized meals prengancy two to four snacks.
Ongoing adjustment of the meal plan is based upon threapy of Insylin monitoring, appetite, and weight-gain patterns, as well as consideration Carbohydrates in Sports Nutrition maternal dietary pregnancyy and work, leisure, and exercise schedules.
Close follow-up is important to ensure nutritional adequacy. Dduring insulin Insulni is added to nutritional Carbohydrates in Sports Nutrition, Resistance training for fat loss primary goal Glutamine and muscle soreness to maintain durjng consistency at Prediabetes mental health and snacks to Insuin insulin pregbancy.
Calories — The caloric requirements of patients Carbohydrates in Sports Nutrition GDM are the same as those thearpy pregnant patients without Curing [ 24 ]. For theraly with a prepregnancy BMI in pfegnancy healthy range, caloric ptegnancy in the first trimester Insullin the same Carbohydrates in Sports Nutrition before pregnancy and generally increase by calories per day in the durinf trimester prgnancy calories per day in the third trimester [ 25 ].
Individuals who are underweight, overweight, or obese should work with a registered dietician to determine their specific caloric requirements. See "Gestational weight gain". Carbohydrate intake — Once the caloric needs are calculated, carbohydrate intake is determined as it is the primary nutrient affecting postprandial glucose levels.
The total amount of carbohydrate consumed, the distribution of carbohydrate intake over meals and snacks, and the type of carbohydrate consumed can be manipulated to blunt postprandial hyperglycemia. Dietary Reference Intakes DRI for all pregnant people is a minimum of g of carbohydrate per day and 28 g of fiber [ 24 ].
There is sparse evidence from randomized trials as to the ideal carbohydrate intake for individuals with GDM. We limit carbohydrate intake to 40 percent of total calories while ensuring that ketonuria does not ensue [ 26,27 ].
Adequately powered studies are needed to evaluate the effect of various dietary interventions on perinatal outcomes in GDM.
Many patients will need individual adjustment of the amount of carbohydrate by 15 to 30 g at each meal, depending on their postprandial glucose levels, which are directly dependent upon the carbohydrate content of the meal or snack [ 28 ]. The postprandial glucose rise can be blunted if the diet is carbohydrate restricted.
However, reducing carbohydrates to decrease postprandial glucose levels may lead to higher consumption of fat, which may have adverse effects on maternal insulin resistance and fetal body composition.
In a meta-analysis of randomized trials of dietary intervention in patients with GDM, low carbohydrate diets had a favorable effect on postprandial blood glucose concentrations and significantly lowered the need for insulin therapy but did not affect other maternal or newborn outcomes eg, macrosomia, cesarean birth, gestational weight gainalthough the data were insufficient to detect small or moderate statistical differences in obstetric outcomes between the patient groups [ 29 ].
See tjerapy considerations in type 2 diabetes mellitus", section on 'Glycemic index and glycemic load'. Protein intake should be distributed throughout the day and included in all meals and snacks to promote satiety, slow the absorption of carbohydrates into the bloodstream, and provide adequate calories.
A bedtime high-protein snack Insilin recommended to prevent accelerated ie, starvation ketosis overnight and maintain fasting glucose levels within the target range. In a retrospective cohort study including over 31, patients with GDM, those with appropriate gestational weight gain table 1 had optimal outcomes, while excessive gestational weight gain was associated with a significantly increased risk of having a large for gestational age newborn, preterm birth, and cesarean birth [ 30 ].
Although suboptimal weight gain increased the likelihood of avoiding pharmacotherapy of GDM and decreased the likelihood of having a large for gestational age newborn, there were also IInsulin small for gestational age newborns in this group 7.
The data in this study were not corrected for potential confounders, such as smoking. See "Obesity in pregnancy: Complications and maternal management" and "Gestational weight gain", section on 'Recommendations for gestational weight gain'.
Some patients experience minimal weight loss one to five pounds or weight stabilization for the first few weeks after beginning nutritional therapy, which should be evaluated in the overall context of gestational weight gain and ongoing surveillance of weight gain in the weeks thereafter.
Weight loss is generally not recommended during pregnancy, although controversy exists regarding this recommendation for patients with obesity, especially class II or III. For pregnant people with obesity, a modest energy restriction of 30 percent below the DRI for pregnant people g carbohydrate, 71 g protein, 28 g fiber [ 24 ] can often be achieved while meeting gestational weight gain recommendations and without causing ketosis [ 31 ].
See "Gestational weight gain", section on 'Recommendations for gestational weight gain'. EXERCISE — Adults with diabetes are encouraged to perform 30 to 60 minutes of moderate-intensity aerobic activity 40 to 60 percent maximal oxygen uptake [VO 2 max] on most days of the week at least minutes of moderate-intensity aerobic exercise per week.
A program of moderate exercise is recommended as part of the treatment plan for patients with diabetes as long as they have no medical or obstetric contraindications to this level of physical activity. Exercise that increases muscle mass, including aerobic, resistance, and circuit training, appears to improve glucose management, primarily from increased tissue sensitivity to insulin.
As a result, exercise can reduce both fasting and postprandial blood glucose concentrations and, in some patients with GDM, the need for insulin may be obviated [ 32 ]. See "Exercise during pregnancy and the postpartum period" and "Exercise guidance in adults with diabetes mellitus".
Glucose meters measure capillary blood glucose, almost all available glucose meters provide plasma equivalent values rather thedapy whole-blood glucose values. Thus, results from most available glucose meters and venous plasma glucose measured in a laboratory should be comparable.
See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus". Intermittent self-monitoring of blood glucose — We suggest that patients self-monitor blood glucose levels [ ]:. Results should be recorded in a glucose log, along with dietary information. This facilitates recognition of glycemic patterns and helps to interpret results stored in the memory of glucose meters.
We prefer the one-hour postprandial measurement as it corresponds more closely to the maximum insulin peak in patients using rapid-acting insulin analogs. The value of fasting plus postprandial durig preprandial measurement was suggested by a trial that randomly assigned 66 insulin-treated patients with GDM to management according to results of fasting plus postprandial monitoring one hour after meals or according to preprandial-only blood glucose concentrations [ 37 ].
Postprandial monitoring had several benefits as compared with preprandial monitoring: better glycemic management glycated hemoglobin [A1C] value 6. Can the frequency of self-monitoring be reduced? Multiple daily measurements allow recognition of patients who should begin pharmacologic therapy.
In a randomized trial of patients with GDM on nutritional therapy who demonstrated glucose levels in the target range after one week of four times daily glucose testing, those assigned to every other day testing had similar birth weights and frequency of macrosomia as those who continued to test four times daily [ 40 ].
Continuous glucose monitoring — Continuous glucose monitoring CGM allows determination of peak postprandial glucose levels, mean glucose level, episodes of nocturnal hyperglycemia, and percent time in range for a hour period. We do not routinely use CGM in patients with GDM because of cost and it has not been proven to improve maternal or fetal outcome, but few trials have been performed.
When CGM was compared with frequent self-monitoring of blood glucose in a meta-analysis of two small randomized trials, outcomes were similar for both approaches: cesarean birth risk ratio [RR] 0. There were no perinatal deaths. Larger trials may clarify whether the favorable trends that were observed are real.
Although use of CGM has no clear advantages for most patients, it may be considered in patients who cannot consistently check fingerstick glucose levels and are willing to wear a device. In addition, some patients choose to use CGM because they want the detailed information about their glucose levels that it provides.
Cost may be a barrier to use. Glucose target — Glucose targets vary among countries and the precise target for optimum maternal, fetal, and newborn outcome is not well-established [ 42 ]. In the United States, the American Diabetes Association ADA and the American College of Obstetricians and Gynecologists ACOG recommend the following upper limits for glucose levels, with insulin therapy initiated if they are exceeded, but acknowledge that these thresholds have been extrapolated from recommendations proposed for pregnant patients with preexisting diabetes [ 24,43 ]:.
These targets are well above the mean glucose values in pregnant people without diabetes described in a literature review of studies of the normal hour glycemic profile of pregnant people [ 44 ]. These levels were derived from measurements on whole blood, plasma, self-monitored capillary glucose measurements, or tissue fluid CGM.
Although glucose levels in whole blood, plasma, and interstitial fluid differ, there was some consistency in the results. Glycated hemoglobin — A1C may be a helpful ancillary test in assessing glycemic management during pregnancy [ 45,46 ]. It is not clear whether or how often it should be monitored in patients with GDM with glucose levels are in the target range.
If measured and there is a discrepancy between the A1C and glucose values, then potential causes should be investigated. High-quality normative data for A1C in each trimester are not available. A1C values tend to be lower in pregnant compared with nonpregnant people [ 47 ] because the average blood glucose concentration is approximately 20 percent lower in pregnant people, and in the first half of pregnancy, there is a rise in red cell mass and a slight increase in red blood cell turnover [ 48,49 ].
Other factors that have been reported to affect A1C values include race although it is not clear whether the higher A1C levels observed in Black persons compared with White persons are due to differences in glucose levels or racial differences in the glycation of hemoglobin [ 50 ] and iron status chronic iron deficiency anemia increases A1C, treatment of iron deficiency anemia with iron lowers A1C.
Sources Ibsulin variation in A1C levels are discussed in detail separately. See "Measurements of chronic glycemia in diabetes mellitus", section on 'Glycated hemoglobin A1C '. Episodes of physiological ketonemia and ketonuria are not uncommon in pregnancy and can occur with hypocaloric diets [ 53 ].
Studies have reported inconsistent findings regarding a potential association between ketonuria and impaired cognitive outcome in offspring [ ]. Goal — The goal of pharmacotherapy is to manage glucose levels so that the majority are no higher than the upper limit of the target range, without inducing any episodes of hypoglycemia.
: Insulin therapy during pregnancy| Insulin Therapy in Gestational Diabetes | IntechOpen | Possible complications for the baby include: Stillbirth fetal death. J Clin Endocrinol Metab ; These risks are doubled if the affected parent developed diabetes before age Prepregnancy couseling and evaluation of women with diabetes mellitus. Pharmacokinetics, efficacy and safety of glyburide for treatment of gestational diabetes mellitus. J Clin Invest ; Combs et al. |
| Insulin for gestational diabetes - NHS | Reassessment of glycemic status should be undertaken at a minimum of every three years eg, every one to three years [ 24 ]. More frequent assessment may be important in patients who may become pregnant again, since early detection of diabetes is important to preconception and early prenatal care. More frequent screening every one or two years may also be indicated in patients with other risk factors for diabetes, such as family history of diabetes, obesity, and need for pharmacotherapy during pregnancy. The best means of follow-up testing has not been defined. The two-hour 75 g oral GTT is the more sensitive test for diagnosis of diabetes and impaired glucose tolerance in most populations, but the fasting plasma glucose is more convenient, specific, and reproducible, and less expensive. A1C is convenient and the preferred test for patients who have not fasted overnight. See "Screening for type 2 diabetes mellitus", section on 'Screening tests'. See "Overview of primary prevention of cardiovascular disease". Follow-up of patients not screened for GDM — For patients who did not undergo screening for GDM, but diabetes is suspected postpartum because of newborn outcome eg, hypoglycemia, macrosomia, congenital anomalies , a postpartum GTT may be considered. A normal postpartum GTT excludes the presence of type 1 or type 2 diabetes or prediabetes; it does not exclude the possibility of GDM during pregnancy and the future risks associated with this diagnosis. Indications for screening and tests used for screening are discussed separately. See "Screening for type 2 diabetes mellitus". SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in pregnancy". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest. We suggest glucose self-monitoring before breakfast and at one or at two hours after the beginning of each meal. See 'Glucose monitoring' above. See 'Can the frequency of self-monitoring be reduced? Moderate exercise also improves glycemic control and should be part of the treatment plan for patients with no medical or obstetric contraindications to this level of physical activity. See 'Rationale for treatment' above and 'Exercise' above. Calories are generally divided over three meals and two to four snacks per day and are composed of approximately 40 percent carbohydrate, 20 percent protein, and 40 percent fat. Gestational weight gain recommendations are shown in the table table 1. See 'Medical nutritional therapy' above. Pharmacotherapy can reduce the occurrence of macrosomia and large for gestational age in newborns. See 'Indications for pharmacotherapy' above. We start with the simplest insulin regimen likely to be effective based on the glucose levels recorded in the patient's blood glucose log and increase the complexity as needed. An alternative approach based on both patient weight and glucose levels is somewhat more complex and likely most appropriate for individuals whose glucose levels are not well managed with simpler paradigms. See 'Insulin' above. The long-term effects of transplacental passage of noninsulin antihyperglycemic agents are not known. See 'Oral hypoglycemic agents' above. Testing can be performed while the patient is still in the hospital after giving birth. Otherwise it is performed 4 to 12 weeks postpartum and, if results are normal, at least every three years thereafter. See 'Maternal prognosis' above. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Gestational diabetes mellitus: Glucose management and maternal prognosis. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Author: Celeste Durnwald, MD Section Editors: David M Nathan, MD Erika F Werner, MD, MS Deputy Editor: Vanessa A Barss, MD, FACOG Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Nov 16, There were no significant maternal or neonatal harms from treatment of GDM. Insulin Dose — The insulin dose required to achieve target glucose levels varies among individuals, but the majority of studies have reported a total dose ranging from 0. Follow-up Testing — Long-term follow-up for development of type 2 diabetes is routinely recommended for individuals with GDM, given their high risk for developing the disorder [ 24,43 ]. Electronic address: pubs smfm. SMFM Statement: Pharmacological treatment of gestational diabetes. Am J Obstet Gynecol ; B2. Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care ; Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med ; HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. Han S, Crowther CA, Middleton P. Interventions for pregnant women with hyperglycaemia not meeting gestational diabetes and type 2 diabetes diagnostic criteria. Cochrane Database Syst Rev ; 1:CD Durnwald CP, Mele L, Spong CY, et al. Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes. Obstet Gynecol ; Uvena-Celebrezze J, Fung C, Thomas AJ, et al. Relationship of neonatal body composition to maternal glucose control in women with gestational diabetes mellitus. J Matern Fetal Neonatal Med ; Catalano PM, Thomas A, Huston-Presley L, Amini SB. Increased fetal adiposity: a very sensitive marker of abnormal in utero development. Am J Obstet Gynecol ; Moss JR, Crowther CA, Hiller JE, et al. Costs and consequences of treatment for mild gestational diabetes mellitus - evaluation from the ACHOIS randomised trial. BMC Pregnancy Childbirth ; US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA ; Pillay J, Donovan L, Guitard S, et al. Screening for Gestational Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. The mediating effects of gestational diabetes on fetal growth and adiposity in women who are overweight and obese: secondary analysis of the LIMIT randomised trial. BJOG ; Landon MB, Rice MM, Varner MW, et al. Mild gestational diabetes mellitus and long-term child health. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care ; 31 Suppl 1:S Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. Hernandez TL, Brand-Miller JC. Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Yamamoto JM, Kellett JE, Balsells M, et al. Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight. Han S, Middleton P, Shepherd E, et al. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev ; 2:CD Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract ; Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition ; Jovanovic-Peterson L, Peterson CM. Dietary manipulation as a primary treatment strategy for pregnancies complicated by diabetes. J Am Coll Nutr ; Reece EA, Hagay Z, Caseria D, et al. Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy? Am J Perinatol ; Okesene-Gafa KA, Moore AE, Jordan V, et al. Probiotic treatment for women with gestational diabetes to improve maternal and infant health and well-being. Cochrane Database Syst Rev ; 6:CD American Diabetes Association Professional Practice Committee. Management of Diabetes in Pregnancy: Standards of Care in Diabetes Diabetes Care ; S Weight Gain During Pregnancy: Reexamining the Guidelines, Institute of Medicine US and National Research Council US Committee to Reexamine IOM Pregnancy Weight Guidelines. Ed , National Academies Press US The Art and Science of Diabetes Self-Management Education, Mensing C Ed , American Association of Diabetes Educators, Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Peterson CM, Jovanovic-Peterson L. Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes ; 40 Suppl Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Cheng YW, Chung JH, Kurbisch-Block I, et al. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Brown J, Ceysens G, Boulvain M. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Laird J, McFarland KF. Fasting blood glucose levels and initiation of insulin therapy in gestational diabetes. Endocr Pract ; Weisz B, Shrim A, Homko CJ, et al. One hour versus two hours postprandial glucose measurement in gestational diabetes: a prospective study. J Perinatol ; Moses RG, Lucas EM, Knights S. Gestational diabetes mellitus. At what time should the postprandial glucose level be monitored? Aust N Z J Obstet Gynaecol ; Sivan E, Weisz B, Homko CJ, et al. One or two hours postprandial glucose measurements: are they the same? de Veciana M, Major CA, Morgan MA, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. Hawkins JS, Casey BM, Lo JY, et al. Weekly compared with daily blood glucose monitoring in women with diet-treated gestational diabetes. Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care ; 30 Suppl 2:S Mendez-Figueroa H, Schuster M, Maggio L, et al. Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring: A Randomized Controlled Trial. Raman P, Shepherd E, Dowswell T, et al. Different methods and settings for glucose monitoring for gestational diabetes during pregnancy. Cochrane Database Syst Rev ; CD Hofer OJ, Martis R, Alsweiler J, Crowther CA. Different intensities of glycaemic control for women with gestational diabetes mellitus. ACOG Practice Bulletin No. Obstet Gynecol ; e Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Griffiths RJ, Vinall PS, Stickland MH, Wales JK. Haemoglobin A1c levels in normal and diabetic pregnancies. Eur J Obstet Gynecol Reprod Biol ; Jovanovic L, Savas H, Mehta M, et al. Frequent monitoring of A1C during pregnancy as a treatment tool to guide therapy. Mosca A, Paleari R, Dalfrà MG, et al. Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Clin Chem ; Lurie S, Mamet Y. Red blood cell survival and kinetics during pregnancy. Bunn HF, Haney DN, Kamin S, et al. The biosynthesis of human hemoglobin A1c. Slow glycosylation of hemoglobin in vivo. J Clin Invest ; Bergenstal RM, Gal RL, Connor CG, et al. Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels. Ann Intern Med ; Pinto ME, Villena JE. Diabetic ketoacidosis during gestational diabetes. A case report. Diabetes Res Clin Pract ; e Graham UM, Cooke IE, McCance DR. A case of euglyacemic diabetic ketoacidosis in a patient with gestational diabetes mellitus. Obstet Med ; Robinson HL, Barrett HL, Foxcroft K, et al. Prevalence of maternal urinary ketones in pregnancy in overweight and obese women. Stehbens JA, Baker GL, Kitchell M. Outcome at ages 1, 3, and 5 years of children born to diabetic women. Churchill JA, Berendes HW, Nemore J. Neuropsychological deficits in children of diabetic mothers. A report from the Collaborative Sdy of Cerebral Palsy. Rizzo T, Metzger BE, Burns WJ, Burns K. Correlations between antepartum maternal metabolism and intelligence of offspring. Naeye RL, Chez RA. Effects of maternal acetonuria and low pregnancy weight gain on children's psychomotor development. Knopp RH, Magee MS, Raisys V, Benedetti T. Metabolic effects of hypocaloric diets in management of gestational diabetes. Langer O, Levy J, Brustman L, et al. Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age? Kjos SL, Schaefer-Graf U, Sardesi S, et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Nicholson WK, Wilson LM, Witkop CT, et al. Therapeutic management, delivery, and postpartum risk assessment and screening in gestational diabetes. Evid Rep Technol Assess Full Rep ; Harrison RK, Cruz M, Wong A, et al. The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus. Balsells M, García-Patterson A, Gich I, Corcoy R. Ultrasound-guided compared to conventional treatment in gestational diabetes leads to improved birthweight but more insulin treatment: systematic review and meta-analysis. Acta Obstet Gynecol Scand ; Dunne F, Newman C, Alvarez-Iglesias A, et al. Early Metformin in Gestational Diabetes: A Randomized Clinical Trial. National Institute for Health and Care Excellence. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. February 25, ; NICE Guideline 3: version 2. Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics FIGO Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet ; Suppl 3:S Harper LM, Glover AV, Biggio JR, Tita A. Predicting failure of glyburide therapy in gestational diabetes. Nicholson W, Bolen S, Witkop CT, et al. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Balsells M, García-Patterson A, Solà I, et al. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ ; h Brown J, Grzeskowiak L, Williamson K, et al. Insulin for the treatment of women with gestational diabetes. Tarry-Adkins JL, Aiken CE, Ozanne SE. Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis. PLoS Med ; e Butalia S, Gutierrez L, Lodha A, et al. Short- and long-term outcomes of metformin compared with insulin alone in pregnancy: a systematic review and meta-analysis. Diabet Med ; Brown J, Martis R, Hughes B, et al. Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes. Neonatal, infant, and childhood growth following metformin versus insulin treatment for gestational diabetes: A systematic review and meta-analysis. Sénat MV, Affres H, Letourneau A, et al. Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes: A Randomized Clinical Trial. Ji J, He Z, Yang Z, et al. Comparing the efficacy and safety of insulin detemir versus neutral protamine hagedorn insulin in treatment of diabetes during pregnancy: a randomized, controlled study. BMJ Open Diabetes Res Care ; 8. Nachum Z, Ben-Shlomo I, Weiner E, Shalev E. Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial. BMJ ; Mathiesen ER, Hod M, Ivanisevic M, et al. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in pregnant women with type 1 diabetes. Hod M, McCance DR, Ivanisevic M, et al. Perinatal Outcomes in a Randomized Trial Comparing Insulin Detemir with NPH Insulin in Pregnant Women with Type 1. Abstract LB. American Diabetes Association. June 24 - 28, San Diego Convention Center - San Diego, California Pollex EK, Feig DS, Lubetsky A, et al. Insulin glargine safety in pregnancy: a transplacental transfer study. Kovo M, Wainstein J, Matas Z, et al. Placental transfer of the insulin analog glargine in the ex vivo perfused placental cotyledon model. Endocr Res ; Suffecool K, Rosenn B, Niederkofler EE, et al. Insulin detemir does not cross the human placenta. Diabetes Care ; e Callesen NF, Damm J, Mathiesen JM, et al. Treatment with the long-acting insulin analogues detemir or glargine during pregnancy in women with type 1 diabetes: comparison of glycaemic control and pregnancy outcome. Mathiesen ER, Ali N, Alibegovic AC, et al. Risk of Major Congenital Malformations or Perinatal or Neonatal Death With Insulin Detemir Versus Other Basal Insulins in Pregnant Women With Preexisting Diabetes: The Real-World EVOLVE Study. Jovanovic L, Pettitt DJ. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Kalafat E, Sukur YE, Abdi A, et al. Metformin for prevention of hypertensive disorders of pregnancy in women with gestational diabetes or obesity: systematic review and meta-analysis of randomized trials. Ultrasound Obstet Gynecol ; Nachum Z, Zafran N, Salim R, et al. Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study. Hebert MF, Ma X, Naraharisetti SB, et al. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther ; Schwartz RA, Rosenn B, Aleksa K, Koren G. Glyburide transport across the human placenta. Bouchghoul H, Alvarez JC, Verstuyft C, et al. Transplacental transfer of glyburide in women with gestational diabetes and neonatal hypoglycemia risk. PLoS One ; e Barbour LA, Scifres C, Valent AM, et al. A cautionary response to SMFM statement: pharmacological treatment of gestational diabetes. Wouldes TA, Battin M, Coat S, et al. Arch Dis Child Fetal Neonatal Ed Landi SN, Radke S, Engel SM, et al. Association of Long-term Child Growth and Developmental Outcomes With Metformin vs Insulin Treatment for Gestational Diabetes. JAMA Pediatr ; Rowan JA, Rush EC, Plank LD, et al. Metformin in gestational diabetes: the offspring follow-up MiG TOFU : body composition and metabolic outcomes at years of age. BMJ Open Diabetes Res Care ; 6:e Hanem LGE, Stridsklev S, Júlíusson PB, et al. Metformin Use in PCOS Pregnancies Increases the Risk of Offspring Overweight at 4 Years of Age: Follow-Up of Two RCTs. J Clin Endocrinol Metab ; Barbour LA, Feig DS. Metformin for Gestational Diabetes Mellitus: Progeny, Perspective, and a Personalized Approach. Rowan JA, Hague WM, Gao W, et al. Metformin versus insulin for the treatment of gestational diabetes. Caritis SN, Hebert MF. A pharmacologic approach to the use of glyburide in pregnancy. Tieu J, Bain E, Middleton P, Crowther CA. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes. Cochrane Database Syst Rev ; :CD Nicklas JM, Zera CA, England LJ, et al. A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial. Phelan S, Phipps MG, Abrams B, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Am J Clin Nutr ; Schwartz N, Nachum Z, Green MS. The prevalence of gestational diabetes mellitus recurrence--effect of ethnicity and parity: a metaanalysis. Getahun D, Fassett MJ, Jacobsen SJ. Gestational diabetes: risk of recurrence in subsequent pregnancies. Moses RG. The recurrence rate of gestational diabetes in subsequent pregnancies. MacNeill S, Dodds L, Hamilton DC, et al. Rates and risk factors for recurrence of gestational diabetes. Pace R, Brazeau AS, Meltzer S, et al. Conjoint Associations of Gestational Diabetes and Hypertension With Diabetes, Hypertension, and Cardiovascular Disease in Parents: A Retrospective Cohort Study. Am J Epidemiol ; Catalano PM, Vargo KM, Bernstein IM, Amini SB. Incidence and risk factors associated with abnormal postpartum glucose tolerance in women with gestational diabetes. Kjos SL, Buchanan TA, Greenspoon JS, et al. Gestational diabetes mellitus: the prevalence of glucose intolerance and diabetes mellitus in the first two months post partum. Waters TP, Kim SY, Werner E, et al. Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes? Vounzoulaki E, Khunti K, Abner SC, et al. Stillbirth is more likely in pregnant people with diabetes. The baby may grow slowly in the uterus due to poor circulation or other conditions, such as high blood pressure or damaged small blood vessels. The exact reason stillbirths happen with diabetes is not known. The risk of stillbirth goes up in women with poor blood glucose control and with blood vessel changes. Birth defects. Birth defects are more likely in babies of people who have diabetes. Some birth defects are serious enough to cause stillbirth. Birth defects usually occur in the first trimester of pregnancy. Babies of people with diabetes may have major birth defects in the heart and blood vessels, brain and spine, urinary system and kidneys, and digestive system. This is the term for a baby that is much larger than normal. All of the nutrients the baby gets come directly from the pregnant person's blood. If the person's blood has too much sugar, the pancreas of the baby makes more insulin to use this glucose. This causes fat to form and the baby grows very large. Birth injury. Birth injury may occur due to the baby's large size and difficulty being born. The baby may have low levels of blood glucose right after delivery. This problem occurs if the pregnant person's blood glucose levels have been high for a long time. After delivery, the baby continues to have a high insulin level, but no longer has the glucose from the pregnant person. This causes the newborn's blood glucose level to get very low. The baby's blood glucose level is checked after birth. If the level is too low, the baby may need glucose in an IV. Trouble breathing respiratory distress. Too much insulin or too much glucose in a baby's system may keep the lungs from growing fully. This can cause breathing problems in babies. This is more likely in babies born before 37 weeks of pregnancy. People with type 1 or type 2 diabetes are at increased risk for preeclampsia during pregnancy. To lower the risk, they should take low-dose aspirin 60 mg to mg a day from the end of the first trimester until the baby is born. Not all types of diabetes can be prevented. Type 1 diabetes often starts when a person is young. Type 2 diabetes may be prevented by losing weight. Healthy food choices and exercise can also help prevent type 2 diabetes. Special testing and keeping track of the baby may be needed for pregnant people with diabetes, especially those who are taking insulin. This is because of the increased risk for stillbirth. These tests may include:. Fetal movement counting. This means counting the number of movements or kicks in a certain period of time, and watching for a change in activity. This is an imaging test that uses sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to look at blood flow through blood vessels. Nonstress testing. Biophysical profile. This is a measure that combines tests, such as the nonstress test and ultrasound to check the baby's movements, heart rate, and amniotic fluid. Doppler flow studies. This is a type of ultrasound that uses sound waves to measure blood flow. A baby of a pregnant person with diabetes may be delivered vaginally or by cesarean section. It will depend on your health, and how much your pregnancy care provider thinks the baby weighs. Your pregnancy care provider may advise a test called amniocentesis in the last weeks of pregnancy. This test takes out some of the fluid from the bag of waters. Testing the fluid can tell if the baby's lungs are mature. The lungs mature more slowly in babies whose parent has diabetes. If the lungs are mature, the healthcare provider may advise induced labor or a cesarean section delivery. Diabetes is a condition in which the body can't produce enough insulin, or it can't use it normally. Nearly all pregnant people without diabetes are screened for gestational diabetes between 24 and 28 weeks of pregnancy. Treatment for diabetes focuses on keeping blood sugar levels in the normal range. Follow-up testing is important. Bring someone with you to help you ask questions and remember what your provider tells you. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you. Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are. Know what to expect if you do not take the medicine or have the test or procedure. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Search Encyclopedia. Diabetes During Pregnancy What is diabetes? There are 3 types of diabetes: Type 1 diabetes. What causes diabetes during pregnancy? |
| Key Messages | More frequent retinal ;regnancy during pregnancy as determined by the vision care Energy policy analysis should be performed for women with more durinb pre-existing retinopathy and poor Carbohydrates in Sports Nutrition therapt, especially those with the greatest Energy boosting supplements reductions in A1C during pregnancy, in tuerapy to Carbohydrates in Sports Nutrition progression of retinopathy [Grade B, Level 1 for type 1 diabetes 25,27 ; Grade D, Consensus for type 2 diabetes]. Rapid implementation of euglycemia in the setting of retinopathy is associated with worsening of retinopathy The association of different insulin therapies in PGDM, pre-pregnancy and mean HbA1c during pregnancy is shown in Table 3. However, it is important to pay close attention to blood glucose levels because insulin requirements can fall rapidly in the first few days after delivery; some individuals require little or no insulin. Contributor Disclosures. |
| Gestational diabetes mellitus: Glucose management and maternal prognosis - UpToDate | In another follow-up study of infants exposed to metformin during pregnancies with gestational diabetes, children exposed to metformin weighed more at the age of 12 months, and were heavier and taller at 18 months, however, body composition was similar as was motor, social and linguistic development. Specific human leukocyte antigen HLA alleles DR3 or DR4 may predispose to the development of type 1 diabetes postpartum, as does the presence of islet-cell autoantibodies [ ] or antibodies against glutamic acid decarboxylase or insulinoma antigen 2. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. In late pregnancy, the hormones estrogen, cortisol, and human placental lactogen can block insulin. For women with pre-existing diabetes, early neonatal feeding should be encouraged immediately postpartum to reduce neonatal hypoglycemia [Grade C, Level 3 ]. |
| Symptoms and Risk Factors | Study interventions durjng Insulin therapy during pregnancy diet only, exercise dhring and combined diet and Alpha-lipoic acid for anti-aging interventions Insulin therapy during pregnancy with standard care. Oral insulin delivery: Existing barriers and current counter-strategies. In women with GDM who duriny insulin and do not tolerate or are inadequately controlled on metformin, glyburide may be used [Grade B, Level 2 ]. Neonatal hypoglycemia and neurodevelopmental outcomes at 2 years. Pregnancy in women with normal glucose metabolism is characterized by fasting levels of blood glucose that are lower than in the nonpregnant state due to insulin-independent glucose uptake by the fetus and placenta and by mild postprandial hyperglycemia and carbohydrate intolerance as a result of diabetogenic placental hormones. |
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