ACOG addresses the management of pregnant women with pregestational diabetes, including specific guidance for the multiple aspects of care. SMFM has provided a sample of an open access checklist in a Special Statement that can be found in ‘Learn More – Primary Sources’.
Insulin During Delivery
Judicious use of operative vaginal delivery is reasonable even in the presence of risk factors for shoulder dystocia
Insulin resistance increases during pregnancy to its highest level in the 3rd trimester, except for late 1st trimester when high levels of estrogen enhance insulin sensitivity and increase risk of maternal hypoglycemia. Maternal mortality from DKA is rare, and fetal mortality has decreased substantially in recent years.
Pregnancy may exacerbate diabetes-related complications
*Corticosteroids: ACOG states
…if corticosteroids are administered to accelerate lung maturation in the setting of an obstetric complication, an increased insulin requirement during the next 5 days should be anticipated, and the patient’s glucose levels should be closely monitored.
ACOG Practice Bulletin 201: Pregestational Diabetes Mellitus
SMFM Special Statement: Updated checklist for antepartum care of pregestational diabetes mellitus
Are you an
ObG Insider?
Get specially curated clinical summaries delivered to your inbox every week for free
Please log in to ObGFirst to access this page
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
It appears you don't have enough CME Hours to take this Post-Test. We no longer offer Hours.
You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site