Tiffany Yeh1, Michele Yeung1, Felicia A Mendelsohn Curanaj2. 1. Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA. 2. Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 East 68th St, Baker 2023, New York, NY, 10065, USA. fam9025@med.cornell.edu.
Abstract
PURPOSE OF REVIEW: There is a rising prevalence of type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) in pregnancy. Reaching and maintaining glycemic targets during and after this time are important for both the health of the mother and her baby. RECENT FINDINGS: Based on recently published guidelines from various societies, we review the diagnosis of diabetes in pregnancy, types of therapies available to maintain euglycemia, important keys to management of T1DM, T2DM, and GDM, and strategies for reaching inpatient glycemic targets during the peripartum period. Care for pregnant patients with T1DM is especially challenging, and providers should be aware of the varying insulin requirements at different stages of pregnancy and how to reduce hypoglycemia and avoid diabetic ketoacidosis. Insulin sensitivity fluctuates throughout pregnancy due to physiologic changes, especially during labor and delivery and immediately post-partum. We review recommendations regarding how to manage this dynamic time and present our own institution's inpatient management protocol. Finally, we review management of diabetes post-partum, including medications, breast-feeding, and continued monitoring and screening. With the collaborative efforts of the patient and an interdisciplinary team and in-depth knowledge of the most up-to-date management principles, it is possible to achieve euglycemia during this critical time of a mother and baby's life.
PURPOSE OF REVIEW: There is a rising prevalence of type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM) in pregnancy. Reaching and maintaining glycemic targets during and after this time are important for both the health of the mother and her baby. RECENT FINDINGS: Based on recently published guidelines from various societies, we review the diagnosis of diabetes in pregnancy, types of therapies available to maintain euglycemia, important keys to management of T1DM, T2DM, and GDM, and strategies for reaching inpatient glycemic targets during the peripartum period. Care for pregnant patients with T1DM is especially challenging, and providers should be aware of the varying insulin requirements at different stages of pregnancy and how to reduce hypoglycemia and avoid diabetic ketoacidosis. Insulin sensitivity fluctuates throughout pregnancy due to physiologic changes, especially during labor and delivery and immediately post-partum. We review recommendations regarding how to manage this dynamic time and present our own institution's inpatient management protocol. Finally, we review management of diabetes post-partum, including medications, breast-feeding, and continued monitoring and screening. With the collaborative efforts of the patient and an interdisciplinary team and in-depth knowledge of the most up-to-date management principles, it is possible to achieve euglycemia during this critical time of a mother and baby's life.
Entities:
Keywords:
Euglycemic diabetic ketoacidosis; Gestational diabetes; Insulin management; Pregnancy; Type 1 diabetes; Type 2 diabetes
Authors: Lisa C Zuckerwise; Erika F Werner; Christian M Pettker; Erin K McMahon-Brown; Stephen F Thung; Christina S Han Journal: Obstet Gynecol Date: 2012-08 Impact factor: 7.661