15. Management of Diabetes in Pregnancy:Standards of Care in Diabetes—2023

Abstract

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the 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 and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Thyroid dysfunction during gestation and gestational diabetes mellitus: a complex relationship

“…Moreover, a history of GDM confers a sevenfold increased risk of T2D in the mother [188][189][190], and a post-partum OGTT and life-long metabolic follow-up are recommended to screen a persistent dysglycemia or a new onset of prediabetes or diabetes, respectively [191]. Furthermore, GDM diagnosed by different criteria (IADSPG vs Carpenter&Coustan) was found differently associated to persistent prediabetes or overt diabetes, being IADSPG criteria less predictive [192].…”

Puerperium experience and lifestyle in women with gestational diabetes mellitus and overweight/obesity in China: A qualitative study

“…The islet cells need to make new assessments and adjustments to meet the body’s insulin requirement ( ElSayed et al, 2023a ). Puerperium is the “window phase” of recovery of glucose metabolism in women with GDM, particularly those who were overweight/obese before pregnancy ( ElSayed et al, 2023b ). Thus, the early postnatal period for initiating and sustaining lifestyle changes is the “window period” for recovery of glucose metabolism and islet function in women with GDM, particularly those who were overweight or obese prior to pregnancy.…”

“…Thus, the early postnatal period for initiating and sustaining lifestyle changes is the “window period” for recovery of glucose metabolism and islet function in women with GDM, particularly those who were overweight or obese prior to pregnancy. The postpartum period is also crucial for healthcare professionals to offer advice and support to women with GDM, considering that changes in lifestyle (such as a healthy diet and increased physical activity) have been shown to prevent the further development of T2DM ( Aroda et al, 2015 ; ElSayed et al, 2023b ).…”

Effect of continuous glucose monitoring compared with self-monitoring of blood glucose in gestational diabetes patients with HbA1c<6%: a randomized controlled trial

“…Glycemic control can reduce perinatal complications, and blood glucose monitoring is a cornerstone of maintaining optimal blood glucose. Although hemoglobin A1c (HbA1c) levels fall during pregnancy due to physiological increases of red blood cell turnover, guidelines recommend an optimal target of HbA1c<6% during pregnancy without significant hypoglycemia ( 5 ). Additionally, as HbA1c represents an integrated measure of glucose, it may not fully capture postprandial hyperglycemia.…”

“…Continuous glucose monitoring (CGM) technologies assess dynamic glucose levels in daily life to measure the duration and magnitude of fluctuation, especially for fasting and postprandial measurements, for 72 h to 14 days ( 7 ). The American Diabetes Association (ADA) suggests that the use of CGM during pregnancy is associated with improved HbA1c levels and neonatal outcomes for pregnant women with type 1 diabetes ( 5 ). However, CGM use in GDM women is controversial.…”