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Diabetes in Pregnancy

Diabetes in Pregnancy. Screening. Gestational Diabetes Mellitus Screening Guidelines. Diabetes risk assessment. High risk. Average to low risk. Screen at confirmation of pregnancy. Screen at 24 to 28 weeks gestation. Postpartum. Screen for diabetes at 6-12 w eeks 1,2. Normoglycemia.

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Diabetes in Pregnancy

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  1. Diabetes in Pregnancy Screening

  2. Gestational Diabetes Mellitus Screening Guidelines • Diabetes risk assessment • High risk • Average to low risk • Screen at confirmation of pregnancy • Screen at 24 to 28 weeks gestation • Postpartum • Screen for diabetes at 6-12 weeks1,2 • Normoglycemia • Diabetes • Prediabetes • Lifelong screening for diabetes every 3 years3 • Treat3 • Positive for GDM • Negative for GDM • Positive for GDM • Negative for GDM • Treat 1. AACE. Endocr Pract. 2011;17(2):1-53. 2. ADA. Diabetes Care. 2013;36(suppl1):S11-S66.

  3. Diabetes in Pregnancy: Risk Factors • 1. AACE. Endocr Pract. 2011;17(2):1-53. 2. ADA. Diabetes Care. 2013;36(suppl1):S11-S66.3. Innes et al. JAMA. 2002;287(19):2534-2541.

  4. GDM Diagnosis • AACE. Endocr Pract. 2011;17(2):1-53. • ADA. Diabetes Care. 2013;36(suppl1):11-66. • Committee on Obstetric Practice. ACOG. 2011;504:1-3.

  5. Diabetes in Pregnancy: Established Diabetes • All women of childbearing age diagnosed with T1DM or T2DM should receive: • Preconception diabetes counseling, includinginformation on the risks of uncontrolled diabetes during pregnancy1 • Preconception evaluation and treatment of diabetes-related complications1 • Counseling on medications contraindicated during pregnancy1,2 • These include statins, angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and most non-insulin antihyperglycemic agents • Counseling on effective contraception for all who wish to avoid pregnancy1 (Slide 1 of 2) ADA. Diabetes Care. 2013;36(suppl1):S11-S66. Kitzmiller JL, et al. Diabetes Care. 2008;31(5):1060-79.

  6. Diabetes in Pregnancy: Established Diabetes • All women of childbearing age diagnosed with T1DM or T2DM should receive: • Intensive pre- and post-conception A1C monitoring • 50% risk reduction in adverse pregnancy outcomes for every 1% decrease in A1C prior to conception1 • Weekly A1C testing after conception can greatly improve glycemic monitoring2 • ADA recommends preconception A1C <7.0%3 • AACE recommends preconception A1C <6.1%4 • Potential contraindications to pregnancy: • Ischemic heart disease, untreated active proliferative retinopathy, renal insufficiency, and severe gastroenteropathy5 (Slide 2 of 2) • Mathiesen ER, et al. Endocrinol Metab Clin N Am. 2011;40:727-738. • JovanovicL. Diabetes Care. 2011;34(1):53-54. • 3. ADA. Diabetes Care. 2013;36(suppl1):S11-S66. • AACE. Endocr Pract. 2011;17(2):1-53. • Jovanovic L, et al. Mt Sinai J Med. 2009;76(3):269-80.

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