Table 1.
Laboratory and special exam components of the initial and subsequent evaluation of pregnant women with preexisting type 1 or type 2 diabetes (in addition to usual prenatal lab tests)
| Initial evaluation | Subsequent testing |
|---|---|
| A1C | Every 1–3 months |
| Fasting lipid profile,* including triglycerides, total, HDL, and LDL cholesterol | As indicated |
| TSHU and thyroid peroxidase antibodies; consider TSH-receptor antibodies if TSH is suppressed <0.03 μU/ml | To monitor treatment |
| Hemoglobin, serum ferritin; consider vitamin B12 in type 1 diabetes | To monitor treatment |
| Consider anti-tTG or anti-EMA plus IgA level in type 1 diabetes to diagnose celiac disease* | Repeat to confirm abnormal result or monitor effect of gluten-free diet |
| ALT/AST; possible liver ultrasound | As indicated |
| Random urine for ACR or 24-h urine collection for microalbuminuria and creatinine clearance (measure 24-h total protein excretion if urine is dipstick positive for albumin or protein). Serum creatinine for estimated GFR if preconception; creatinine clearance if pregnant | Every 1–3 months if abnormal |
| Dilated retinal exam* | Every 1–6 months according to risk of progression |
| Assess risk factors for CHD. Resting ECG* in asymptomatic patients age 35 years or older (note changes of prior silent ischemia, LVH, and QTc). Women with suspect angina, atypical chest pain, significant dyspnea, abnormal ECG, or other reasons to suspect CHD should have cardiology consultation with stress ECG, stress echocardiogram, or another appropriate imaging technique* | As indicated |
| Consider testing* for cardiac autonomic neuropathy (heart rate variability with deep breathing, blood pressure response to standing) | As indicated |
| Consider 2-D or Doppler echocardiogram or tissue Doppler imaging* with indication of diabetic cardiomyopathy or systolic or diastolic heart failure | As indicated |
| Consider testing* for peripheral arteriosclerotic vascular disease if high risk (carotid ultrasound, ankle/brachial blood pressure) | As indicated |
*
May be delayed or omitted if performed before pregnancy. EMA, endomyosial antibody; LVH, left ventricular hypertrophy; QTc, Q-T interval controlled for heart rate; tTG, tissue transglutaminase.