Table 2.

Pregnancy checklist

Table 2	Pregnancy checklist
Achieve optimal glycemic control	HbA1C < 6 %, or as low as possible without hypoglycemia
Medication assessment	Safety for pregnancy should be assessed -If patient on glargine, switch to detemir -Discontinue statins (ideally preconception) -Stop ACE-Is and ARBs (ideally preconception) -Aspirin 81 mg daily from 12–36 weeks (to help reduce risk of preeclampsia)
Medical nutrition counseling	Optimize accuracy of carbohydrate counting for glucose control -Focus on consistent timing and quality of healthy meals
Blood pressure control for chronic hypertension	Target blood pressure systolic blood pressure 110–129 mmHg and diastolic blood pressure 65–79 mmHg -Use an agent acceptable in pregnancy
Dilated retinal exam	Approximately every trimester or more often if active retinal changes -Laser therapy is treatment of choice for PDR
Nephropathy assessment	Preeclampsia may be difficult to distinguish from worsening diabetic nephropathy and hypertension
Thyroid assessment	Goal TSH first trimester <2.5, 2nd, and 3rd trimester <3 -Increase LT4 dose by 30 % at conception and up to 50 % during pregnancy, usually during first 20 weeks -If patient euthyroid at conception and TPO antibodies positive, monitor TSH every 4–6 weeks during pregnancy In patients with previous history of Graves’ disease, target total T4 is 1.5 times upper range of normal to avoid fetal hypothyroidism. -Propylthiouracil is treatment of choice in first trimester, methimazole is treatment of choice in second and third trimester -Monitor thyroid receptor antibodies if maternal thyroid treated with RAI or surgery to assess for possible fetal exposure