Diabetes in Pregnancy Author: Elisha L. Brownfield, MD
Editorial changes - 2009-10-30
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
Additional Resources
Tools
Patient Education
  • Instruct all diabetic women of childbearing potential on the need for pre-conception planning.
  • Stress the importance of diet and exercise to control glucose levels in pregnant diabetic patients.
  • Continue preventive foot care in women with pregestational diabetes.
  • Recommend smoking cessation in all women with diabetic pregnancies.
  • Teach patients and family members to recognize hypoglycemia and to treat it appropriately.
  • Counsel patients on the need for an ophthalmology exam before conception or in early pregnancy.

Instruct all diabetic women of childbearing potential on the need for pre-conception planning. B

  • 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.
  • Plan the pregnancies of diabetic women to achieve fasting whole-blood glucose levels of 70 to 100 mg/dL and 2-hour postprandial levels of <140 mg/dL at least 8 to 12 weeks before conception.
  • Arrange for a certified diabetic educator instruction on diabetes self-management.
Background | Back to top


Stress the importance of diet and exercise to control glucose levels in pregnant diabetic patients. A

  • Provide nutritional counseling consistent with the American Diabetes Association recommendations.
  • Consider recommending to pregnant diabetic patients:
    • A 30% to 33% calorie restriction in pregnant women with diabetes and a body mass index >30
    • Limiting carbohydrate intake to 35% to 40% of calories
    • A program of moderate exercise
Background | Back to top


Continue preventive foot care in women with pregestational diabetes. C

  • Stress the importance of continuing daily foot inspection, proper foot coverings, and toenail care in women with pregestational diabetes.
Background | Back to top


Recommend smoking cessation in all women with diabetic pregnancies. C

  • Urge smoking cessation at each visit in diabetic women who are pregnant or planning pregnancy.
  • See module Smoking Cessation.
Background | Back to top


Teach patients and family members to recognize hypoglycemia and to treat it appropriately. C

  • Teach patients and family members to recognize the signs and symptoms of hypoglycemia and about its treatment.
Background | Back to top


Counsel patients on the need for an ophthalmology exam before conception or in early pregnancy. BC

  • Obtain a dilated retinal exam before pregnancy.
Background | Back to top

FAQs
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.

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.
PIER is copyrighted (c) 2010 by the American College of Physicians,
190 N. Independence Mall West, Philadelphia, PA 19106-1572, USA.