Endocrine Society GUIDELINES Bundle

Diabetes and Pregnancy

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11 6.0. Labor, Delivery, Lactation, and Postpartum Care Blood Glucose Targets During Labor and Delivery Î 6.1. ES suggests target blood glucose levels of 72-126 mg/dL (4.0- 7.0 mmol/L) during labor and delivery for pregnant women with overt or gestational diabetes. (2|⊕⊕ ) Lactation Î 6.2a. ES recommends women with overt or gestational diabetes, whenever possible, should breastfeed their infants. (1|⊕⊕⊕⊕) Î 6.2b. ES recommends women with overt diabetes who are breastfeeding and successfully using metformin or glyburide therapy during pregnancy should continue to use these medications, when necessary, during breastfeeding. (1|⊕⊕⊕⊕) Postpartum Contraception Î 6.3. ES recommends the choice of a contraceptive method for a woman with overt diabetes or a history of gestational diabetes should not be influenced by virtue of having overt diabetes or a history of gestational diabetes. (1|⊕⊕⊕ ) Screening for Postpartum Thyroiditis Î6.4. ES suggests women with type 1 diabetes be screened for postpartum thyroiditis with a TSH at 3 and 6 months postpartum. (2|⊕⊕ ) Postpartum Care Î 2.4a. ES recommends postpartum care for women who have had gestational diabetes should include measurement of fasting plasma glucose or fasting self-monitored blood glucose for 24-72 hours after delivery to rule out ongoing hyperglycemia. (1|⊕ ) Î 2.4b. ES recommends a 2-hour, 75-g OGTT should be undertaken 6-12 weeks after delivery in women with gestational diabetes to rule out prediabetes or diabetes. (1|⊕⊕⊕ ) If results are normal, we recommend this or other diagnostic tests for diabetes should be repeated periodically as well as before future pregnancies. (1|⊕⊕ ) Î 2.4c. ES suggests the child's birth weight and whether or not the child was born to a mother with gestational diabetes become part of the child's permanent medical record. (U) Î 2.4d. ES recommends all women who have had gestational diabetes receive counseling on lifestyle measures to reduce the risk of type 2 diabetes, the need for future pregnancies to be planned, and the need for regular diabetes screening, especially before any future pregnancies. (1|⊕ ) Î2.4e. ES suggests blood glucose-lowering medication should be discontinued immediately after delivery for women with gestational diabetes unless overt diabetes is suspected, in which case the decision to continue such medication should be made on a case-by-case basis. (2|⊕⊕ ) Intra- and Postpartum Care

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