Guidelines have been formulated for the management of pregnant women with diabetes; the clinical practice guideline has been published in the the Journal of Clinical Endocrinology & Metabolism.
Ian Blumer, M.D., from the Charles H. Best Diabetes Centre in Whitby, Canada, and colleagues developed an evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to address important clinical issues in the management of women with diabetes during pregnancy.
According to the guidelines, all pregnant women should undergo testing for diabetes, ideally before 13 weeks of gestation, with a fasting plasma glucose level of 92 to 125 mg/dL as the diagnostic criteria for gestational diabetes and ≥126 mg/dL indicative of overt diabetes. Pregnant women not previously identified as having diabetes should undergo gestational diabetes testing with a 75-g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation.
Initial treatment of gestational diabetes should include medical nutrition therapy and moderate daily exercise. Obese women with overt or gestational diabetes should reduce their calorie intake. If lifestyle therapy is insufficient to maintain normoglycemia, blood glucose-lowering pharmacotherapy should be initiated. Women who have had gestational diabetes should undergo an OGTT six to 12 weeks after delivery to rule out prediabetes or diabetes.
All women who have had gestational diabetes should undergo lifestyle management counseling to reduce the risk of type 2 diabetes, as well as regular diabetes screening, especially before future pregnancies.
“The guideline synthesizes evidence-based strategies to support women who have diabetes during pregnancy,” Blumer said in a statement.
Two authors disclosed financial ties to the pharmaceutical and health care industries.