Diabetes

Gestational Diabetes[GDM] is present in two to three percent of all pregnancies are complicated by and 15% of patients require insulin during pregnancy [Class A2].

Diabetes will often be diet controlled [Class A1] but up to 60% of patients with GDM will become overtly diabetic 5-10 years postpartum. Thus, patients should be screened at 6 weeks after delivery and yearly thereafter.

Diabetes Risk Factors Include:

• Obesity *
  
• Positive family history * [First degree relative]
  
• History of glucose intolerance *
  
• History of a macrosomic baby, stillbirth or congenital
  anomaly
  
• Hispanic, African American, Native American or Pacific Islands ethnicity
  
• Advanced maternal age

* Patients with these risk factors should be screened at the 1st prenatal visit and later at 24-28 weeks

Pregestational Diabetes

Less than 10% of all women with diabetes in pregnancy have pregestational diabetes. Less than 0.5% of women with diabetes in the US receive preconception counseling and their infants are at significant risk for congenital anomalies.

Glycemic control before and during pregnancy may reduce this risk. Patients using oral hypoglycemics should switch to insulin preconception and ACE inhibitors should be discontinued preconception.

Services Provided by DM in Pregnancy Program:

• Preconception counseling & management
  
• Nutritional counseling by certified perinatal dietitian
  
• Diabetic teaching by certified diabetic educators including: risks in pregnancy, glucometer use, injection and insulin administration techniques and exercise counseling
  
• Perinatal consultation regarding ante-, intra- and/or postpartum care for women with diabetes
  
• Ultrasound services for fetal morphology and, if needed, fetal echocardiography
  
• Support group meetings for patients and their significant others
  
• Services available range from consultation only, co-management, or assumption of total obstetrical and diabetic care

* If 1° PG > 190 no need for 3°OGTT ==>
FBS and 1° postprandial instead
** ADA Clinical practice recommendations & 4th International Workshop on GDM 1998

• Types of Diabetes
• Gestational Diabetes
• Screening for Diabetes in Pregnancy
• Management of Diabetes During Pregnancy
• Past Pregnancy
• Supplemental Insulin
• Nutrition and Diabetes
• Carbohydrates and Diabetes
• Glucose Monitoring
• Hypoglycemia
• Hyperglycemia
• Exercise with Diabetes During Pregnancy
• Medications for Diabetes
• Effects of Diabetes on the Mother
• Effects of Diabetes on the Baby
• Preconception Care
• Substance Abuse in Pregnancy
• Postpartum Care

More information from the Children's Hospital of the King's Daughters

This information is not intended to substitute or replace the professional medical advice you receive from your physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your physician with any questions or concerns you may have regarding a medical condition.