Diabetes in Pregnancy Author: Elisha L. Brownfield, MD
Editorial changes - 2012-04-19
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up

Tables
References
Glossary
What's New
Patient Information
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Clinical Information
Guideline
   Annals of Internal Medicine
 Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement
 Screening for gestational diabetes mellitus: a systematic review for the U.S. Preventive Services Task Force
   British Medical Journal
 Management of diabetes from preconception to the postnatal period: summary of NICE guidance
   Diabetes Care
 Gestational diabetes mellitus
 Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications
 Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care
   Obstetrics & Gynecology
 Screening for gestational diabetes mellitus: recommendations and rationale
Article
   Acta Obstetricia et Gynecologica Scandinavica
 Gestational diabetes: a reappraisal of HBA1c as a screening test
   American Journal of Obstetrics and Gynecology
 The postprandial glucose profile in the diabetic pregnancy
 The influence of obesity and diabetes on the risk of cesarean delivery
 Insulin and glyburide therapy: dosage, severity level of gestational diabetes, and pregnancy outcome
 Screening for gestational diabetes: different cut-offs for different ethnicities?
 Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial
 Detection of gestational diabetes mellitus by homeostatic indices of insulin sensitivity: a preliminary study
 Positive association between a single abnormal glucose tolerance test value in pregnancy and subsequent abnormal glucose tolerance.
 Predicting gestational diabetes: choosing the optimal early serum marker.
 Diabetes mellitus and birth defects
   American Journal of Public Health
 Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups.
   Annals of Internal Medicine
 Comparative Effectiveness and Safety of Medications for Type 2 Diabetes: An Update Including New Drugs and 2-Drug Combinations
   Archives of Internal Medicine
 A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus
   BJOG
 Fasting capillary glucose as a screening test for gestational diabetes mellitus
   British Medical Journal
 Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands
 Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study
 Type 1 diabetes and pregnancy
 Effectiveness of continuous glucose monitoring in pregnant women with diabetes: randomised clinical trial
   Canadian Family Physician
 Managing diabetes during pregnancy. Guide for family physicians
 Preconception care for women with type 1 diabetes
   Diabetes
 Increased serum IGF-I during pregnancy is associated with progression of diabetic retinopathy
   Diabetes Care
 Declining insulin requirement in the late first trimester of diabetic pregnancy
 Progression of retinopathy during pregnancy in type 1 diabetic women treated with insulin lispro
 Diabetes and abnormal glucose tolerance in women with previous gestational diabetes
 Association of elevated serum ferritin levels and the risk of gestational diabetes mellitus in pregnant women: The Camden study
   Diabetic Medicine
 Oral hypoglycaemic agents in 118 diabetic pregnancies
 Hypertensive disorders of pregnancy in women with Type 1 and Type 2 diabetes
 Continuous glucose monitoring for treatment adjustment in diabetic pregnancies—a pilot study
 Gestational diabetes: Dilemma caused by multiple international diagnostic criteria.
   Journal of Maternal-Fetal and Neonatal Medicine
 Consequences of smoking and caffeine consumption during pregnancy in women with type 1 diabetes
   Lancet
 Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study
   New England Journal of Medicine
 Effect of treatment of gestational diabetes mellitus on pregnancy outcomes
 Major congenital malformations after first-trimester exposure to ACE inhibitors
 Hyperglycemia and adverse pregnancy outcomes
 Metformin versus insulin for the treatment of gestational diabetes
 A multicenter, randomized trial of treatment for mild gestational diabetes
 A multicenter, randomized trial of treatment for mild gestational diabetes.
   Obstetrics & Gynecology
 Continuous glucose monitoring for the evaluation of gravid women with type 1 diabetes mellitus
   Pediatrics
 Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus
 Do multivitamin supplements attenuate the risk for diabetes-associated birth defects?
Review
   Annals of Internal Medicine
 Intensive Insulin Therapy in Hospitalized Patients: A Systematic Review
   BMJ
 Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis.
   Clinical Obstetrics and Gynecology
 Postpartum care of the woman with diabetes
   Cochrane Library
 Dietary advice in pregnancy for preventing gestational diabetes mellitus (Cochrane Review)
 Dietary regulation for ‘gestational diabetes’ (Cochrane Review)
 Very tight versus tight control for diabetes in pregnancy (Cochrane Review)
 Induction of labour for suspected fetal macrosomia (Cochrane Review)
 Elective delivery in diabetic pregnant women (Cochrane Review)
 Treatments for gestational diabetes and impaired glucose tolerance in pregnancy (Cochrane Review)
   Current Diabetes Reports
 Development of early-onset type 2 diabetes in the young: implications for child bearing
   Herz
 Asymptomatic coronary artery disease in a pregnant patient. A case report and review of literature
   Journal of Maternal-Fetal & Neonatal Medicine
 New and future diabetes therapies: are they safe during pregnancy?
   Journal of the American Medical Association
 Manifestations of chronic disease during pregnancy
   Lancet
 Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis
 Gestational diabetes: the need for a common ground
   Maternal and Child Health Journal
 Preconception care: a systematic review
Commentary
   ACP Journal Club
      Abnormal pregnancy
 2005 - Screening and active management reduced perinatal complications more than routine care in gestational diabetes
 2002 - Review: Antihypertensive drugs do not differ for comparative benefit or risk in severe hypertension during pregnancy
      Diabetes mellitus
 2010 - Review: Statin use increases risk for diabetes
 2009 - Pioglitazone was associated with lower risk for adverse cardiovascular events than rosiglitazone in older patients
 2009 - A lifestyle intervention improved obstructive sleep apnea more than support and education in obese patients with diabetes
 2009 - A Mediterranean-style diet reduced need for glucose-lowering drugs more than a low-fat diet in type 2 diabetes
 2009 - Minimally invasive and conventional glucose monitoring did not differ for long-term glycemic control in insulin-treated diabetes
 2009 - Rosiglitazone was noninferior to metformin plus sulfonylurea for CV events but increased risk for HF and fractures in type 2 diabetes
 2009 - Review: Intensive glucose control reduced some CV events but did not change mortality in type 2 diabetes
 2009 - Bariatric surgery was cost-effective at 2 years for management of type 2 diabetes in obese patients
 2009 - Bariatric surgery was dominant over conventional therapy for lifetime management of type 2 diabetes in obese patients
 2008 - Review: Metformin reduces risk for CV mortality compared with other oral diabetes drugs or placebo in type 2 diabetes
 2008 - Intensive insulin therapy reduced long-term risk for incident hypertension in type 1 diabetes
 2008 - Benefits of early intensive glucose control to prevent diabetes complications were sustained for up to 10 years
 2008 - Benefits of tight blood pressure control to prevent diabetes complications were not sustained
 2008 - Glycemic control was not affected by self-monitoring of blood glucose in type 2 diabetes
 2008 - Self-monitoring of blood glucose was not cost-effective in non-insulin-treated type 2 diabetes
 2008 - Intensive insulin therapy improved glycemic control more than oral hypoglycemic agents in newly diagnosed type 2 diabetes
 2008 - Intensive glucose control did not prevent important complications in type 2 diabetes
 2008 - Intensive glucose control increased mortality and did not prevent cardiovascular events in type 2 diabetes
 2008 - Review: Little evidence exists on the benefits and harms of screening for and treating gestational diabetes
 2008 - A targeted, multifactorial intervention reduced mortality in patients with type 2 diabetes and microalbuminuria
 2008 - Adjustable gastric banding improved glycemic control in obese patients with type 2 diabetes
 2008 - Review: Statins prevent stroke and reduce mortality
 2007 - Thiazolidinediones increased risk for heart failure, myocardial infarction, and death in older patients with type 2 diabetes
 2007 - Aerobic plus resistance training was more effective than either alone for reducing HbA1c levels in type 2 diabetes
 - Review: Long-acting insulin analogues do not improve glycemic control but do reduce nocturnal hypoglycemia in diabetes
 2007 - Review: beta-blockers for hypertension increase risk for new-onset diabetes compared with nondiuretic antihypertensive agents
 2007 - Review: Thiazolidinediones increase congestive heart failure but not cardiovascular deaths in prediabetes or type 2 diabetes
 2007 - Self-monitoring of blood glucose did not improve glycemic control in patients with type 2 diabetes not treated with insulin
 2007 - Review: Incretin therapy improves glycemic control more than placebo in patients with type 2 diabetes
 2007 - Review: Thiazolidinediones increase risk for heart failure in type 2 diabetes
 2007 - Impaired fasting glucose and impaired glucose tolerance, as well as known diabetes, increased risk for death within 5 years
 2007 - Review: Meglitinide analogues reduce glucose levels in type 2 diabetes, but morbidity and mortality effects are unknown
 2007 - Review: Rosiglitazone increases risk for MI but does not differ from other drugs for CV death in type 2 diabetes
 2007 - Rosiglitazone increased heart failure but did not differ from metformin plus sulfonylurea for other CV outcomes at interim analysis
 2007 - A portion-control plate was effective for weight loss in obese patients with type 2 diabetes mellitus
 2007 - Review: Long-acting insulin analogues reduce risk for hypoglycemia compared with NPH insulin in type 2 diabetes
 2007 - Vildagliptin was effective as add-on therapy in type 2 diabetes inadequately controlled with metformin monotherapy
 2007 - Intensive insulin therapy during cardiac surgery did not reduce mortality or morbidity but increased risk for stroke
 2007 - Review: Angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors have the lowest risk for diabetes
 2007 - Vildagliptin was noninferior to rosiglitazone for glycemic control in type 2 diabetes but caused less weight gain
 2006 - A lifestyle intervention continued to prevent type 2 diabetes in high-risk patients after the program was stopped
 2006 - Review: Inhaled insulin provides better glycemic control than oral hypoglycemic agents but not better than subcutaneous insulin
 2006 - Sitagliptin improved glycemic control and beta-cell function in type 2 diabetes
 2006 - Simvastatin was cost-effective across a broad range of risk and age groups
 2006 - Rosiglitazone reduced type 2 diabetes but increased heart failure in patients with impaired glycemic control
 2006 - Ramipril did not reduce incident diabetes in patients with impaired glycemic control
 2006 - Review: ACE inhibitors and angiotensin-receptor blockers reduce diabetes in hypertension and other CV risk factors
 2006 - Atorvastatin did not prevent cardiovascular events in type 2 diabetes
 2006 - Adjunctive inhaled insulin before meals improved glycemic control more than adjunctive metformin in type 2 diabetes mellitus
 2005 - Intensive insulin therapy reduced cardiovascular disease in type 1 diabetes
 2005 - Review: Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers prevent type 2 diabetes
 2005 - Candesartan prevented development of diabetes mellitus in heart failure
 2005 - Screening and active management reduced perinatal complications more than routine care in gestational diabetes
 2005 - Review: alpha-Glucosidase inhibitors improve glycemic control but have uncertain effects on patient-important outcomes in type 2 diabetes
 2005 - A lifestyle intervention or metformin prevented or delayed the onset of the metabolic syndrome in persons at risk
 2005 - Review: Mixed signals from trials concerning pharmacologic prevention of type 2 diabetes mellitus
 2004 - Review: Insulin monotherapy and insulin combined with oral hypoglycemic agents provide similar glycemic control
 2004 - Review: Short-acting insulin analogues reduce glycosylated hemoglobin more than regular human insulin but only in adults with type 1 diabetes
 2005 - Diuretic-based therapy reduced cardiovascular mortality in older patients with isolated systolic hypertension and diabetes
 2004 - A dietitian-led intervention reduced weight and waist circumference in obese patients with type 2 diabetes
 2004 - Review: Fluoxetine, orlistat, and sibutramine modestly reduce weight in type 2 diabetes
 2003 - Review: Metformin does not increase risk for lactic acidosis or increase lactate levels in type 2 diabetes
 2003 - Review: Interventions focusing on patient behaviors in provider-patient interactions improve diabetes outcomes
 2003 - Acarbose reduced the risk for cardiovascular disease and hypertension in impaired glucose tolerance
 - Review: Rosiglitazone or pioglitazone as add-on therapy is effective for glycemic control in type 2 diabetes
 2003 - Enalapril reduced the risk for new-onset diabetes in left ventricular dysfunction
 2003 - A counseling strategy was better than usual care for adopting and maintaining physical activity in type 2 diabetes
 2003 - Combining fasting plasma glucose and glycosylated hemoglobin improved the accuracy for detecting patients with diabetes
 2002 - Training in flexible intensive insulin management improved glycemic control and quality of life in type 1 diabetes
 2002 - Losartan reduced cardiovascular morbidity and mortality more than atenolol in patients with diabetes and essential hypertension
 2002 - Review: Metformin does not increase fatal or nonfatal lactic acidosis or blood lactate levels in type 2 diabetes mellitus
 2002 - A split regimen of regular insulin at dinner and NPH insulin at bedtime reduced nocturnal hypoglycemia in type 1 diabetes
 2002 - A lifestyle intervention or metformin prevented or delayed the onset of type 2 diabetes in persons at risk
 2001 - Review: Stress hyperglycemia after ischemic stroke indicates a greater risk for death in patients without diabetes
 2001 - Several simple rules predicted complications in high-risk patients with diabetes
 2001 - Cardiovascular events were increased in high cardiovascular risk patients with albuminuria
 2001 - Changes in diet and physical activity prevented type 2 diabetes mellitus in persons with impaired glucose tolerance
 2001 - Review: Self-management training in type 2 diabetes mellitus is effective in the short term
 2000 - Glyburide was as safe and effective as insulin in gestational diabetes
 2000 - Review: Self-monitoring does not improve blood glucose control in type 2 diabetes mellitus
      Endocrinology, Diabetes, and Metabolism
 2009 - Treatment of mild gestational diabetes did not prevent neonatal complications but reduced fetal overgrowth
 - Review: Oral drugs for gestational diabetes do not increase adverse maternal and neonatal outcomes more than insulin
 2008 - Review: Little evidence exists on the benefits and harms of screening for and treating gestational diabetes
 2008 - Nondiabetic maternal hyperglycemia was associated with adverse pregnancy outcomes
 2008 - Metformin (alone or with insulin) was as effective as insulin for preventing perinatal complications in gestational diabetes
 2005 - Screening and active management reduced perinatal complications more than routine care in gestational diabetes
 2004 - Review: Short-acting insulin analogues reduce glycosylated hemoglobin more than regular human insulin but only in adults with type 1 diabetes
      Obstetrics/gynecology
 2009 - Quadrivalent HPV vaccine reduced risk for HPV infection and related disease in women 24 to 45 years of age
 - Review: Oral drugs for gestational diabetes do not increase adverse maternal and neonatal outcomes more than insulin
 2008 - Influenza immunization during pregnancy reduced influenza in infants and respiratory illness in mothers
 2008 - Nondiabetic maternal hyperglycemia was associated with adverse pregnancy outcomes
 2008 - Metformin (alone or with insulin) was as effective as insulin for preventing perinatal complications in gestational diabetes

Patient Information
Web
 ACP Foundation HEALTH TiPS: Diabetes
 Agency for Healthcare Research and Quality: Gestational Diabetes: A Guide for Pregnant Women
 American Academy of Family Physicians: Gestational Diabetes: What it Means for Me and My Baby
 American Diabetes Association: Diabetes and Pregnancy
 American Diabetes Association: Gestational Diabetes
 Centers for Disease Control and Prevention: Pregnancy, Diabetes, and Women's Health
 March of Dimes: Gestational Diabetes
 National Institute of Child Health and Human Development: Gestational Diabetes
 National Institute of Child Health and Human Development: Diabetes_During_Pregnancy
 National Institute of Child Health and Human Development: Am I At Risk for Gestational Diabetes?
 National Institute of Child Health and Human Development: A Patient's Guide to a Healthy Pregnancy
 ACP Foundation HEALTH TiPS: Diabetes (Spanish)
 Agency for Healthcare Research and Quality: Gestational Diabetes: A Guide for Pregnant Women (Spanish)
FAQs | Patient Information
Elisha L. Brownfield, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Justin B. Moore, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.


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