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Rationale:
- In the postpartum period, altered schedules, lactation, and changing physiology may change a woman's insulin requirements.
- Gestational diabetes is generally a transient state, and insulin resistance decreases immediately postpartum.
- Women on oral agents before pregnancy can usually restart them after delivery.
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Evidence:
- Case series have reported decreased insulin requirement after delivery in women with pregestational diabetes (19).
- There is limited evidence available outlining the risks and benefits to the breast-feeding infant when the mother is taking
oral hypoglycemic agents (49).
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Comments:
- The effect of oral diabetes drugs on breast-feeding infants is largely unknown. The issue should be addressed in conjunction
with the infant's primary care provider.
- The term “gestational diabetes” covers a wide array of physiologic syndromes, including types 1 and 2 diabetes first detected
during pregnancy and pregnancy-related insulin resistance. Therefore, postpartum diabetes care should be individualized.
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Elisha L. Brownfield, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for
continuing medical education grand rounds and lectures given.
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
or PDFs may rapidly become obsolete. Therefore, PIER users should
compare the date of the last update on the website with any printout
to ensure that the information being referred to is the most current
available.
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PIER is copyrighted (c) 2010 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.
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Diabetes in Pregnancy
> Follow-up
