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
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