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Managing diabetes during pregnancy. Guide for family physicians
1Department of Family Medicine, Queen's University, Kingston, Ont. sempowsk@post.queensu.ca
Summary
Family physicians can manage diabetes in pregnancy using evidence-based guidelines. Optimal glycemic control reduces risks like congenital anomalies and stillbirths for both mother and child.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Family Medicine
Background:
- Gestational diabetes mellitus (GDM) and pregestational diabetes require careful management during pregnancy.
- Evidence regarding screening and treatment recommendations has been conflicting.
Purpose of the Study:
- To guide family physicians in interpreting evidence for managing diabetes in pregnancy.
- To develop a practical management model for these patients.
Main Methods:
- Literature review of randomized controlled trials (RCTs) and descriptive studies (1980-2002).
- Analysis of studies on intensive insulin therapy (Level I evidence).
- Inclusion of consensus statements from national societies for glycemic targets.
Main Results:
- Screening for GDM is recommended for most pregnant women.
- Good glycemic control significantly reduces congenital anomalies and stillbirths.
- Intensive insulin therapy lowers macrosomia risk and may reduce cesarean rates.
Conclusions:
- Family physicians can manage pregnant patients with diabetes using available evidence.
- A structured approach to managing pregestational and gestational diabetes is feasible.