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. 2003 Jun;49:761–767.

Managing diabetes during pregnancy. Guide for family physicians.

Ian P Sempowski 1, R L Houlden 1
PMCID: PMC2214247  PMID: 12836864

Abstract

OBJECTIVE: To provide a guide family physicians can use to interpret current evidence on treating women with pregestational and gestational diabetes mellitus (GDM) and to develop a model for managing these patients. QUALITY OF EVIDENCE: A MEDLINE search from January 1980 to December 2002 found randomized controlled trials (RCTs) and descriptive studies that had conflicting results regarding screening recommendations. Studies of intensive insulin therapy were predominantly large RCTs (level I evidence). Glycemic targets and guidelines for monitoring pregnant women are based primarily on consensus statements from large national societies. MAIN MESSAGE: Most pregnant women should be screened for GDM. Good glycemic control during pregnancy reduces congenital anomalies and stillbirths. Women failing to meet glycemic targets should be referred to multidisciplinary teams and considered for insulin therapy. Intensive insulin therapy reduces the risk of macrosomia and might reduce cesarean section rates and other serious outcomes. CONCLUSION: Despite controversy, family physicians can follow a plan for managing diabetic patients during pregnancy that is supported by the best available evidence.

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Selected References

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  1. American College of Obstetricians and Gynecologists Committee on Practice Bulletins--Obstetrics ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol. 2001 Sep;98(3):525–538. [PubMed] [Google Scholar]
  2. Berger Howard, Crane Joan, Farine Dan, Armson Anthony, De La Ronde Sandra, Keenan-Lindsay Lisa, Leduc Line, Reid Gregory, Van Aerde John, Maternal-Fetal Medicine Committee Screening for gestational diabetes mellitus. J Obstet Gynaecol Can. 2002 Nov;24(11):894–912. doi: 10.1016/s1701-2163(16)31047-7. [DOI] [PubMed] [Google Scholar]
  3. Buchanan T. A., Kjos S. L. Gestational diabetes: risk or myth? J Clin Endocrinol Metab. 1999 Jun;84(6):1854–1857. doi: 10.1210/jcem.84.6.5714. [DOI] [PubMed] [Google Scholar]
  4. Buchanan T. A., Kjos S. L., Schafer U., Peters R. K., Xiang A., Byrne J., Berkowitz K., Montoro M. Utility of fetal measurements in the management of gestational diabetes mellitus. Diabetes Care. 1998 Aug;21 (Suppl 2):B99–106. [PubMed] [Google Scholar]
  5. Danilenko-Dixon D. R., Van Winter J. T., Nelson R. L., Ogburn P. L., Jr Universal versus selective gestational diabetes screening: application of 1997 American Diabetes Association recommendations. Am J Obstet Gynecol. 1999 Oct;181(4):798–802. doi: 10.1016/s0002-9378(99)70304-2. [DOI] [PubMed] [Google Scholar]
  6. Diabetes Control and Complications Trial Research Group Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. Diabetes Care. 2000 Aug;23(8):1084–1091. doi: 10.2337/diacare.23.8.1084. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ginsberg N. A., Moisidis C. How to predict recurrent shoulder dystocia. Am J Obstet Gynecol. 2001 Jun;184(7):1427–1430. doi: 10.1067/mob.2001.115117. [DOI] [PubMed] [Google Scholar]
  8. Griffin M. E., Coffey M., Johnson H., Scanlon P., Foley M., Stronge J., O'Meara N. M., Firth R. G. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabet Med. 2000 Jan;17(1):26–32. doi: 10.1046/j.1464-5491.2000.00214.x. [DOI] [PubMed] [Google Scholar]
  9. Jovanovic-Peterson L., Durak E. P., Peterson C. M. Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes. Am J Obstet Gynecol. 1989 Aug;161(2):415–419. doi: 10.1016/0002-9378(89)90534-6. [DOI] [PubMed] [Google Scholar]
  10. Langer O., Conway D. L., Berkus M. D., Xenakis E. M., Gonzales O. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med. 2000 Oct 19;343(16):1134–1138. doi: 10.1056/NEJM200010193431601. [DOI] [PubMed] [Google Scholar]
  11. Langer O., Mazze R. The relationship between large-for-gestational-age infants and glycemic control in women with gestational diabetes. Am J Obstet Gynecol. 1988 Dec;159(6):1478–1483. doi: 10.1016/0002-9378(88)90578-9. [DOI] [PubMed] [Google Scholar]
  12. Langer O., Rodriguez D. A., Xenakis E. M., McFarland M. B., Berkus M. D., Arrendondo F. Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol. 1994 Apr;170(4):1036–1047. doi: 10.1016/s0002-9378(94)70097-4. [DOI] [PubMed] [Google Scholar]
  13. MacNeill S., Dodds L., Hamilton D. C., Armson B. A., VandenHof M. Rates and risk factors for recurrence of gestational diabetes. Diabetes Care. 2001 Apr;24(4):659–662. doi: 10.2337/diacare.24.4.659. [DOI] [PubMed] [Google Scholar]
  14. McFarland M. B., Langer O., Conway D. L., Berkus M. D. Dietary therapy for gestational diabetes: how long is long enough? Obstet Gynecol. 1999 Jun;93(6):978–982. doi: 10.1016/s0029-7844(98)00547-x. [DOI] [PubMed] [Google Scholar]
  15. Meltzer S., Leiter L., Daneman D., Gerstein H. C., Lau D., Ludwig S., Yale J. F., Zinman B., Lillie D. 1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association. CMAJ. 1998;159 (Suppl 8):S1–29. [PMC free article] [PubMed] [Google Scholar]
  16. Miller E., Hare J. W., Cloherty J. P., Dunn P. J., Gleason R. E., Soeldner J. S., Kitzmiller J. L. Elevated maternal hemoglobin A1c in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med. 1981 May 28;304(22):1331–1334. doi: 10.1056/NEJM198105283042204. [DOI] [PubMed] [Google Scholar]
  17. Nachum Z., Ben-Shlomo I., Weiner E., Shalev E. Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial. BMJ. 1999 Nov 6;319(7219):1223–1227. doi: 10.1136/bmj.319.7219.1223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Naylor C. D., Sermer M., Chen E., Farine D. Selective screening for gestational diabetes mellitus. Toronto Trihospital Gestational Diabetes Project Investigators. N Engl J Med. 1997 Nov 27;337(22):1591–1596. doi: 10.1056/NEJM199711273372204. [DOI] [PubMed] [Google Scholar]
  19. O'Leary J. A., Leonetti H. B. Shoulder dystocia: prevention and treatment. Am J Obstet Gynecol. 1990 Jan;162(1):5–9. doi: 10.1016/0002-9378(90)90809-l. [DOI] [PubMed] [Google Scholar]
  20. O'SULLIVAN J. B., MAHAN C. M. CRITERIA FOR THE ORAL GLUCOSE TOLERANCE TEST IN PREGNANCY. Diabetes. 1964 May-Jun;13:278–285. [PubMed] [Google Scholar]
  21. Persson B., Stangenberg M., Hansson U., Nordlander E. Gestational diabetes mellitus (GDM). Comparative evaluation of two treatment regimens, diet versus insulin and diet. Diabetes. 1985 Jun;34 (Suppl 2):101–105. doi: 10.2337/diab.34.2.s101. [DOI] [PubMed] [Google Scholar]
  22. Perucchini D., Fischer U., Spinas G. A., Huch R., Huch A., Lehmann R. Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. BMJ. 1999 Sep 25;319(7213):812–815. doi: 10.1136/bmj.319.7213.812. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Pettitt D. J., Knowler W. C. Long-term effects of the intrauterine environment, birth weight, and breast-feeding in Pima Indians. Diabetes Care. 1998 Aug;21 (Suppl 2):B138–B141. [PubMed] [Google Scholar]
  24. Rodrigues S., Robinson E., Gray-Donald K. Prevalence of gestational diabetes mellitus among James Bay Cree women in northern Quebec. CMAJ. 1999 May 4;160(9):1293–1297. [PMC free article] [PubMed] [Google Scholar]
  25. Sacks D. A., Greenspoon J. S., Abu-Fadil S., Henry H. M., Wolde-Tsadik G., Yao J. F. Toward universal criteria for gestational diabetes: the 75-gram glucose tolerance test in pregnancy. Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):607–614. doi: 10.1016/0002-9378(95)90580-4. [DOI] [PubMed] [Google Scholar]
  26. Scherbaum W. A., Lankisch M. R., Pawlowski B., Somville T. Insulin Lispro in pregnancy--retrospective analysis of 33 cases and matched controls. Exp Clin Endocrinol Diabetes. 2002 Jan;110(1):6–9. doi: 10.1055/s-2002-19987. [DOI] [PubMed] [Google Scholar]
  27. Silverman B. L., Rizzo T. A., Cho N. H., Metzger B. E. Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Diabetes Care. 1998 Aug;21 (Suppl 2):B142–B149. [PubMed] [Google Scholar]
  28. Spellacy W. N., Miller S., Winegar A., Peterson P. Q. Macrosomia--maternal characteristics and infant complications. Obstet Gynecol. 1985 Aug;66(2):158–161. [PubMed] [Google Scholar]
  29. Towner D., Kjos S. L., Leung B., Montoro M. M., Xiang A., Mestman J. H., Buchanan T. A. Congenital malformations in pregnancies complicated by NIDDM. Diabetes Care. 1995 Nov;18(11):1446–1451. doi: 10.2337/diacare.18.11.1446. [DOI] [PubMed] [Google Scholar]
  30. Xiong X., Saunders L. D., Wang F. L., Demianczuk N. N. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet. 2001 Dec;75(3):221–228. doi: 10.1016/s0020-7292(01)00496-9. [DOI] [PubMed] [Google Scholar]

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