13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes—2018

Abstract

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Novel therapies for diabetes mellitus in pregnancy

“…1310 Preconception counseling visits can also include assessment for comorbidities and a review of drugs to discuss potential teratogenic effects. Preconception counseling may also be useful in women at high risk for gestational diabetes, including those who are overweight or obese, have a history of previous gestational diabetes, have a strong family history of diabetes, or have impaired glucose tolerance (fig 3).…”

“…Weight gain recommendations are based on the Institute of Medicine’s guidelines for weight gain during pregnancy, which account for maternal body mass index but are unchanged by a diagnosis of diabetes in pregnancy 11. Exercise may improve glucose tolerance during pregnancy in women with gestational diabetes, and the ACOG and ADA have endorsed exercise as a helpful adjunct therapy in the treatment of diabetes 134…”

“…The ACOG and the Endocrine Society support a low carbohydrate diet, whereas the ADA and the Fifth International Workshop on Gestational Diabetes have withdrawn specific recommendations on diet or macronutrients for women with diabetes because of the absence of adequate RCTs 341314. A diet low in simple carbohydrates (33-40% of calories) is thought to limit postprandial glucose excursions and the associated risk of excessive fetal growth 15.…”

“…Diabetes affects 6-9% of pregnancies with approximately 99% of women having gestational diabetes, 0.5% having type 2 diabetes, and 0.3% having type 1 diabetes 1234. In particular, the prevalence of gestational diabetes varies by population and diagnostic criteria 5.…”

“…In particular, the prevalence of gestational diabetes varies by population and diagnostic criteria 5. The prevalence of both gestational and pregestational diabetes is increasing, likely owing to the increasing obesity rates 2367. All types of diabetes are associated with increased risk for hypertensive disorders of pregnancy, excessive fetal growth, fetal demise, macrosomia, and neonatal morbidity, along with long term risks for obesity and diabetes in the offspring 89.…”