Management of diabetes in pregnancy

A team approach to diabetes management optimizes pregnancy outcomes for mother and baby. Patients with preexisting diabetes require intensive insulin therapy before conception and during pregnancy. Glucose self-monitoring assists in achieving near-normal glucose levels during pregnancy, with the goal of maintaining fasting glucose levels from 60 to 105 mg per dL (3.3 to 5.8 mmol per L) and postprandial levels less than 120 mg per dL (6.7 mmol per L). Universal screening at 24 to 28 weeks of gestation identifies women with gestational diabetes. Dietary measures are used initially in the management of gestational diabetes, with the addition of insulin therapy if glucose levels exceed 105 mg per dL (5.8 mmol per L) in a fasting state or 120 mg per dL (6.7 mmol per L) two hours postprandial. Self-monitoring of blood glucose levels four or more times a day guides insulin and dietary modifications. Women with gestational diabetes have a higher risk of developing non-insulin-dependent diabetes later in life and, thus, warrant long-term follow-up.