14. Management of Diabetes in Pregnancy:Standards of Medical Care in Diabetes—2020

Abstract

The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidencegrading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. DIABETES IN PREGNANCY The prevalence of diabetes in pregnancy has been increasing in the U.S. in parallel with the worldwide epidemic of obesity. Not only is the prevalence of type 1 diabetes and type 2 diabetes increasing in women of reproductive age, but there is also a dramatic increase in the reported rates of gestational diabetes mellitus. Diabetes confers significantly greater maternal and fetal risk largely related to the degree of hyperglycemia but also related to chronic complications and comorbidities of diabetes. In general, specific risks of diabetes in pregnancy include spontaneous abortion, fetal anomalies, preeclampsia, fetal demise, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and neonatal respiratory distress syndrome, among others. In addition, diabetes in pregnancy may increase the risk of obesity, hypertension, and type 2 diabetes in offspring later in life (1,2). PRECONCEPTION COUNSELING Recommendations 14.1 Starting at puberty and continuing in all women with diabetes and reproductive potential, preconception counseling should be incorporated into routine diabetes care. A 14.2 Family planning should be discussed, and effective contraception (with consideration of long-acting, reversible contraception) should be prescribed and used until a woman's treatment regimen and A1C are optimized for pregnancy. A 14.3 Preconception counseling should address the importance of achieving glucose levels as close to normal as is safely possible, ideally A1C ,6.5% (48 mmol/mol), to reduce the risk of congenital anomalies, preeclampsia, macrosomia, and other complications. B All women of childbearing age with diabetes should be informed about the importance of achieving and maintaining as near euglycemia as safely possible prior Suggested citation: American Diabetes Association. 14. Management of diabetes in pregnancy:

<p>A Review of Research Progress on Glycemic Variability and Gestational Diabetes</p>

“…Dalfra et al 33 found that diet therapy alone can improve GV in pregnant women with GDM. The 2020 ADA guidelines 55 specify that a good lifestyle (diet control and proper exercise) is an important part of GDM management. About 70%-85% of women diagnosed with GDM can control postprandial hyperglycemia and reduce GV by simply changing lifestyles, which can meet the treatment needs of many women.…”

“…Reasonable insulin treatment can help make the blood glucose of patients with gestational diabetes stable to reach the standard. 55 However, unreasonable insulin application may increase the risk of hypoglycemia, including not properly adjusting insulin doses, not monitoring and adjusting the insulin dose in a timely manner, and not receiving sufficient health education. Therefore, in clinical practice, it is necessary to carry out health education for patients and guide patients to monitor blood glucose on a timely basis and adjust insulin dosage to avoid blood glucose fluctuations caused by hypoglycemia.…”

<p>Effect of Elevated Ketone Body on Maternal and Infant Outcome of Pregnant Women with Abnormal Glucose Metabolism During Pregnancy</p>

“…At present, the guidelines of various diabetes associations worldwide all mention ketosis in the management of gestational diabetes, but the focuses are different (The specific content is shown in Table 1). [32][33][34][35] Among them, the guidelines of the American Diabetes Association, the American College of Obstetricians and Gynecologists, and the Joint British Diabetes Societies focus more on the prevention of diabetic acidosis, while the International Federation of Obstetrics and Gynecology and the Chinese Diabetes Society focus more on the relationship between the diet control and the occurrence of starvation ketosis to discuss the monitoring of ketone bodies.…”

Enfermedades cardio-metabólicas en el embarazo: Revisión sobre diagnóstico, tratamiento y proyección del riesgo cardiovascular a largo plazo

“…Para las pacientes insulinorrequirientes se plantean metas en ayunas <95 mg/dL y posprandiales <120 mg/dL. 42 Teniendo en cuenta esto, ¿una meta más estricta favorece menores desenlaces cardiovasculares y obstétricos?…”