Management and Tests for Diabetes in Pregnancy

Preconception Care and Initial Assessment

The American Diabetes Association recommends that pregnant women with diabetes require intensive glycemic control with insulin as first-line therapy, targeting fasting glucose <95 mg/dL and 1-hour postprandial <140 mg/dL, combined with comprehensive screening for complications and close monitoring throughout pregnancy 1, 2
Before pregnancy or at first prenatal visit, perform comprehensive diabetes-specific testing, including A1C measurement, serum creatinine and urine albumin-to-creatinine ratio, comprehensive dilated eye exam, ECG, lipid panel, TSH, blood pressure measurement, comprehensive foot exam, and neurological exam 1, 3

The American College of Obstetricians and Gynecologists recommends targeting fasting plasma glucose <95 mg/dL and 1-hour postprandial <140 mg/dL or 2-hour postprandial <120 mg/dL 1, 2
The American Diabetes Association recommends an optimal target A1C <6% if achievable without significant hypoglycemia, but may relax to <7% if necessary to prevent hypoglycemia 1, 5, 2

The Endocrine Society recommends that insulin is the preferred and recommended first-line pharmacologic agent because it does not cross the placenta to a measurable extent 6, 2

The Academy of Nutrition and Dietetics recommends referring to a registered dietitian nutritionist within the first week of diagnosis to establish an individualized food plan, with a minimum of 175g carbohydrate daily, 71g protein daily, and 28g fiber daily 5, 6

The American College of Obstetricians and Gynecologists recommends fasting glucose daily upon waking, postprandial glucose after each main meal, and choosing either 1-hour or 2-hour postprandial measurements consistently 6

The American College of Obstetricians and Gynecologists recommends prescribing low-dose aspirin 60-150 mg/day by the end of the first trimester to lower the risk of preeclampsia in all women with type 1 or type 2 diabetes 2

The American Diabetes Association recommends that women with preexisting diabetic retinopathy need close monitoring during pregnancy to assess for progression and provide treatment if indicated 1, 3, 2
The Endocrine Society recommends that pregnancy creates accelerated starvation and ketosis at lower glucose levels, and DKA can occur with glucose <200-250 mg/dL, and if euglycemic DKA develops, start continuous IV insulin immediately even with normal glucose, while simultaneously administering 10% dextrose IV 7

The American College of Obstetricians and Gynecologists recommends that all women with gestational diabetes must be tested at 4-12 weeks postpartum using a 75g oral glucose tolerance test with non-pregnancy diagnostic criteria, and do not use A1C at this visit because concentration may still be influenced by pregnancy changes and/or peripartum blood loss 6, 2
The American Diabetes Association recommends that women with a history of gestational diabetes have a 50-70% risk of developing type 2 diabetes over 15-25 years, and perform lifelong screening for diabetes at least every 3 years 6, 2