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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)
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Review blood glucose logs at every visit and adjust insulin accordingly.  |
- 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.
| Background | Back to top
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Review diabetes drugs after delivery and make changes as necessary. |
- 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.
| Background | Back to top
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Screen women with pregestational diabetes for the development or worsening of diabetic complications during pregnancy. |
- 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.
| Background | Back to top
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Plan future pregnancies postpartum. |
| Background | Back to top
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After delivery, classify patients found to be diabetic during pregnancy and arrange for long-term follow-up. |
- 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.
| Background | Back to top
| | | FAQs |
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| Elisha L. Brownfield, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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The information included herein should never be used as a substitute
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PIER is copyrighted (c) 2009 by the American College of Physicians,
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Diabetes in Pregnancy
