Diabetes in Pregnancy Author: Elisha L. Brownfield, MD
Editorial changes - 2012-04-19
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Follow-up
  • Review blood glucose logs at every visit and adjust insulin accordingly.
  • Review diabetes drugs after delivery and make changes as necessary.
  • Screen women with pregestational diabetes for the development or worsening of diabetic complications during pregnancy.
  • Plan future pregnancies postpartum.
  • After delivery, classify patients found to be diabetic during pregnancy and arrange for long-term follow-up.
Elements of Follow-up for Pregestational and Gestational Diabetes Mellitus (table)

Review blood glucose logs at every visit and adjust insulin accordingly. C

  • Encourage pregnant diabetic women to check glucose levels fasting and 2 hours after every meal, and to record the levels with time of day, food intake, activity, and insulin doses given.
  • Adjust insulin to achieve fasting whole blood glucose levels of 70 to 100 mg/dL and 2-hour postprandial levels of <140 mg/dL.
  • Inform women about the signs and symptoms of hypoglycemia and develop an action plan to treat it acutely.
  • Monitor hemoglobin A1c levels every 2 to 3 months and aim for normal levels.
  • Continue frequent, daily blood glucose testing after delivery.
  • See table Elements of Follow-up for Pregestational and Gestational Diabetes Mellitus.
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Review diabetes drugs after delivery and make changes as necessary. C

  • Adjust insulin in patients with type 1 pregestational diabetes postdelivery according to multiple, daily blood glucose testing to maintain hemoglobin A1c at <7%.
  • Stop insulin in women with gestational diabetes after delivery and monitor glucose levels.
  • Consider the reinstitution of oral diabetes medication in women with type 2 pregestational diabetes postdelivery.
  • See table Elements of Follow-up for Pregestational and Gestational Diabetes Mellitus.
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Screen women with pregestational diabetes for the development or worsening of diabetic complications during pregnancy. C

  • Refer patients with pregestational diabetes for a dilated retinal exam early in pregnancy and postpartum.
  • Measure blood pressure and screen for proteinuria at each prenatal and postpartum visit.
  • Ask about symptoms of neuropathy at each prenatal and postpartum visit.
  • Screen women with type 1 diabetes for thyroid disease postpartum.
  • See table Elements of Follow-up for Pregestational and Gestational Diabetes Mellitus.
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Plan future pregnancies postpartum. C

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After delivery, classify patients found to be diabetic during pregnancy and arrange for long-term follow-up. C

  • Continue home glucose monitoring in women found to be diabetic during pregnancy at least 6 weeks postpartum to determine if they have underlying type 1 or 2 diabetes or if their hyperglycemia resolves.
  • Counsel patients with transient gestational diabetes on the long-term need for diabetes screening.
  • Recommend nutrition and exercise consistent with American Diabetes Association guidelines to patients with transient hyperglycemia of pregnancy after delivery.
  • See table Elements of Follow-up for Pregestational and Gestational Diabetes Mellitus.
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FAQs
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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