Endocrine Society GUIDELINES Bundle

Diabetes and Pregnancy

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1 Preconception Care Preconception Glycemic Control Î 1.2. ES suggests women with diabetes seeking to conceive strive to achieve blood glucose and HbA1c levels as close to normal as possible when they can be safely achieved without undue hypoglycemia. (2|⊕⊕ ) (see Recommendations 3.2a-d and Table 3.) Insulin Therapy Î 1.3a. ES recommends insulin-treated women with diabetes seeking to conceive be treated with multiple daily doses of insulin or continuous SC insulin infusion in preference to split-dose, premixed insulin therapy, because the former are more likely to allow for the achievement and maintenance of target blood glucose levels before conception and, in the event of pregnancy, are more likely to allow for sufficient flexibility or precise adjustment of insulin therapy. (1|⊕⊕ ) Î 1.3b. ES suggests a change to a woman's insulin regimen, particularly when she starts continuous SC insulin infusion, be undertaken well in advance of withdrawing contraceptive measures or otherwise trying to conceive to allow the patient to acquire expertise in, and the optimization of, the chosen insulin regimen. (U) Î 1.3c. ES suggests insulin-treated women with diabetes seeking to conceive be treated with rapid-acting insulin analog therapy (with insulin aspart or insulin lispro) in preference to regular (soluble) insulin. (2|⊕⊕ ) Î 1.3d. ES suggests women with diabetes successfully using the long-acting insulin analogs insulin detemir or insulin glargine before conception may continue with this therapy during pregnancy. (2|⊕⊕ ) Folic Acid Supplementation Î 1.4. ES recommends, beginning 3 months before withdrawing contraceptive measures or otherwise trying to conceive, a woman with diabetes take a daily folic acid supplement to reduce the risk of neural tube defects. (1|⊕⊕ ) ES suggests a daily dose of 5 mg based on this dose's theoretical benefits. (2|⊕⊕ )

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