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- Counsel all diabetic women of childbearing potential on the need for pregnancy planning.
- Counsel all obese women of childbearing age on the need for diet and exercise to decrease the risk of gestational diabetes.
- Stop ACE inhibitor therapy, switch oral hypoglycemics to insulin, and review all other medications before conception.
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Counsel all diabetic women of childbearing potential on the need for pregnancy planning.  |
- Ensure effective birth control at all times, unless the patient is trying to conceive and is in good diabetic control.
- Counsel women with type 1 or 2 diabetes on the risks of fetal malformation associated with unplanned pregnancies and poor metabolic control.
- Achieve fasting whole-blood glucose levels of 70 to 100 mg/dL and 2-hour postprandial levels of <140 mg/dL in diabetic women planning pregnancies.
| Background | Back to top
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Counsel all obese women of childbearing age on the need for diet and exercise to decrease the risk of gestational diabetes.  |
- Provide nutritional counseling to obese women of childbearing age consistent with American Diabetes Association recommendations.
- Consider recommending to obese women planning pregnancy or already pregnant:
- A 30% to 33% calorie restriction if BMI >30
- Limiting fat intake to <30% of calories
- Increasing physical activity, as recommended outside pregnancy, or a program of moderate exercise if the woman is already pregnant
| Background | Back to top
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Stop ACE inhibitor therapy, switch oral hypoglycemics to insulin, and review all other medications before conception. |
- Stop all ACE-inhibitors and angiotensin-receptor blockers.
- Switch oral hypoglycemic agents to insulin therapy.
- Stop cholesterol-lowering drugs.
- Stop aspirin therapy.
- Review other medications and stop any potential teratogens.
| 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.
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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PIER is copyrighted (c) 2010 by the American College of Physicians,
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Diabetes in Pregnancy
