gynecology and obstetrics
Diabetes Mellitus in Pregnancy
Key Points
Diabetes in pregnancy increases risk of fetal macrosomia, shoulder dystocia, preeclampsia, cesarean delivery, stillbirth, and, if preexisting or gestational diabetes is poorly controlled during organogenesis, major congenital malformations and spontaneous abortion. Screen all pregnant women for gestational diabetes using an oral glucose tolerance test. Involve a diabetes team if available, and aim to keep fasting blood glucose levels at < 95 mg/dL (< 5.3 mmol/L) and 2-hour postprandial levels at ≤ 120 mg/dL (≤ 6.6 mmol/L). Begin antenatal testing at 32 weeks and deliver by 39 weeks. Adjustinsulindose immediately after delivery of the placenta. 