6
Care During Pregnancy
Management of Elevated Blood Glucose
Î 2.3a. ES recommends women with gestational diabetes target blood
glucose levels as close to normal as possible. (1|⊕⊕
)
Î 2.3b. ES recommends the initial treatment of gestational diabetes
should consist of medical nutrition therapy (see section 4) and daily
moderate exercise for 30 minutes or more. (1|⊕⊕⊕
)
Î 2.3c. ES recommends using blood glucose-lowering pharmacologic
therapy if lifestyle therapy is insufficient to maintain normoglycemia in
women with gestational diabetes. (1|⊕⊕⊕⊕)
3.0 Glucose Monitoring and Glycemic Targets
Self-monitoring of Blood Glucose
Î 3.1. ES recommends self-monitoring of blood glucose in all pregnant
women with gestational or overt diabetes (1|⊕⊕⊕⊕) and suggests
testing before and either 1 or 2 hours after the start of each
meal (choosing the postmeal time when it is estimated that peak
postprandial blood glucose is most likely to occur) and, as indicated,
at bedtime and during the night. (2|⊕⊕
)
Glycemic Targets (Table 3)
Î 3.2a. ES recommends pregnant women with overt or gestational
diabetes strive to achieve a target preprandial blood glucose
<95 mg/dL (5.3 mmol/L). (1|⊕⊕
for fasting target, 1|⊕
for
other meals)
Î 3.2b. ES suggests that an even lower fasting blood glucose target of
<90 mg/dL (5.0 mmol/L) be strived for (2|⊕
) if this can be safely
achieved without undue hypoglycemia.
Î 3.2c. ES suggests pregnant women with overt or gestational diabetes
strive to achieve a target blood glucose level <140 mg/dL (7.8 mmol/L)
1 hour after the start of a meal and <120 mg/dL (6.7 mmol/L) 2 hours
after the start of a meal (2|⊕
) when these targets can be safely
achieved without undue hypoglycemia.
Î 3.2d. ES suggests pregnant women with overt diabetes strive to
achieve an HbA1c <7% (ideally <6.5%). (2|⊕
)
