A new era of diabetes in pregnancy care is here, one in which technology is very much interwoven with glucose management. In recognition of this, the fully revised seventh edition of this manual includes updates on how continuous glucose monitoring, sensors, and other technology have become tools for pregnant people to use in order to achieve the best outcomes.
Additionally, there is increased recognition of the vast disparities that exist in healthcare access and healthcare outcomes. Where possible, this edition provides updated data on management strategies with equipoise so that each patient can receive the most individualized, high-quality care.
Topics covered include:
Preparing for pregnancy
Lifestyle management for diabetes in pregnancy
Glycemic goals and assessment
Medications for diabetes in pregnancy
Risk assessment, fetal surveillance, and delivery
Postpartum care and contraception
Neonatal care
"Index", Medical Management of Pregnancy Complicated by Diabetes, Erika F. Werner, MD, MS
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Note: Page numbers followed by an f refer to figures. Page numbers followed by a t refer to tables. Page numbers in bold indicate an in-depth discussion.
A
A1C, 64–65
continuous glucose monitoring and, 61
factors affecting, 64, 65t
and fetal risks, 7, 8t, 75, 99, 112
as management tool, 65
and retinopathy, 12
AAP. See American Academy of Pediatrics
abdominal circumference, fetal, 112
abortion, spontaneous, 6–8, 10, 76, 99–100
ACE inhibitors, 12
acetaminophen, 61
acidemia
fetal, 82
neonatal, 156
ACOG. See American College of Obstetricians and Gynecologists
adrenaline, 63
AFI. See amniotic fluid index
AFP (α-fetoprotein), 106, 107t, 109
age, gestational, 111–112, 149
albumin, 65
alcohol, 2, 17, 46
α-fetoprotein (AFP), 106, 107t, 109
ambulatory glucose profiles, 62
American Academy of Pediatrics (AAP), 125, 159, 161
American College of Obstetricians and Gynecologists (ACOG), 54, 56–61, 77, 109–111, 117, 154. See also specific findings and recommendations
American Diabetes Association (ADA), 54, 56–57, 59–61, 77. See also specific findings and recommendations
amino acids, 42
amniocentesis, 106, 108t, 110–111
amniotic fluid index (AFI), 113–114
amniotic fluid levels, 112, 113–114
amylose, foods high in, 42
anatomical ultrasound scan, 112
anemia, 44, 45, 129
aneuploidy, testing for, 106, 109–111, 112
angiotensin-converting enzyme (ACE) inhibitors, 12
angiotensin receptor blockers (ARBs), 12
Annovera, 136t, 137
antenatal corticosteroids, 81–82, 97, 157
antenatal testing, 99, 106, 107, 113–115
antiemetic medications, 95–96
antihistamines, 95
antihypertensive drugs, 12
antipsychotics, atypical, 96
anus, imperforate, 155
aspart (insulin aspart), 16, 18t, 78, 78t
aspirin, 12
assessment. See also screening
neonatal, 149, 155, 161
prepregnancy, 11–14, 11t
atypical antipsychotics, 96
B
barrier contraceptive methods, 135, 136t
basal-bolus regimen, prepregnancy, 15–17
basal stage, of insulin secretion, 77–78
β-hydroxybutyrate, 31, 160
β-hydroxybutyric acid, 66
betamethasone, 81–82
bilirubin, elevated levels in neonate, 160–161
biophysical profile, 99, 108t, 113–114
biparietal diameter, 112
birth control. See contraception birth injury, 30, 117, 155–156
birth weight. See also macrosomia
caloric restriction and, 31
glucose levels and, 57
bladder exstrophy, 155
blood glucose. See glucose levels; glucose monitoring
blood pressure, 12, 98, 124
BMI. See body mass index
body mass index (BMI), 27, 29–32, 128
brachial plexus trauma, 156
brain anomalies, congenital, 154
breastfeeding, 122, 125–126
colostrum collection, 123
diabetes and complications in, 125
hypoglycemia with, 82
insulin requirements with, 76f, 82
nutrition for, 33t–34t, 35t, 126–129, 126t, 127t
oral antidiabetes medication use during, 82
recommendations for, 125
weight loss with, 128
breast infections, 125–126
bronchopulmonary dysplasia, 157
C
caffeine, 45, 46t, 95
calcium
low levels in neonate, 159–160
nutritional requirement in pregnancy, 44–45
calcium channel blockers, 97
calorie requirements
in pregnancy, 37–38, 38t
prepregnancy, 14, 14t
calorie restriction, in pregnancy, 30–32
candidal infections, breast, 125–126
capillary blood glucose, 54, 59–62. See also self-monitoring of blood glucose
carbohydrates
glucose levels affected by, 63–64
and hyperemesis, 94–95, 96
for postpartum nutrition, 128
for pregnancy nutrition, 37, 38–39
for prepregnancy nutrition, 14–15
cardiomyopathy, neonatal, 155
cardiovascular disease, risk in offspring, 162–163
cardiovascular malformations, 154
caudal regression syndrome, 154
cell-free fetal DNA testing, 106, 108t, 110
central nervous system anomalies, 154
cesarean delivery, 106, 116–118
insulin management for, 82, 83t
maternal weight gain and, 30
salpingectomy with, 144
CGM. See continuous glucose monitoring
chest-feeding. See breastfeeding
Choose Your Foods: Food Lists for Diabetes, 35
chorionic villus sampling (CVS), 106, 108t, 110
chromium, 45
cleft lip and palate, 155
COCs. See combination oral contraceptives
cognitive development, 158, 163–164
colon, neonatal small left, 155
colostrum, 123
combination oral contraceptives (COCs), 134, 137, 142–143
efficacy of, 136t
risks/risk categories of, 138t–140t
complications, 91–103.See also specific complications
congenital anomalies, 6–8, 99–100, 152–155
A1C levels and, 7, 8t, 75, 99, 112
pathogenesis of, 153–154
prepregnancy counseling on, 8, 10
screening for, 106, 108t, 109–110, 112, 154
types and rates of, 6, 7t, 152–153, 153t
continuous glucose monitoring (CGM), 54, 61–62, 80–81
barriers to successful, 61–62
intermittently scanned, 61
real-time, 61
standardized metrics for, 62, 62t
continuous subcutaneous insulin infusion (CSII)
delivery failure in, 17
insulin used in, 17
intrapartum use of, 82
in pregnancy, 74, 79–80
prepregnancy, 15–17
contraception, 133–148
barrier methods of, 135, 136t
combined estrogen and progestin, 136t, 137, 142–143
counseling on, 3, 9, 135, 145
efficacy of, 136t
hormonal, 134, 136t, 137–144
long-acting reversible, 135, 136t, 137–142
progestin-only, 134, 136t, 138t–140t, 143–144
risks/risk categories of, 137, 138t–140t, 142
sterilization for, 134, 135, 136t, 144, 145t
contraindications, to pregnancy, 10, 13, 13t
contra-insulin hormones, 63, 76
copper-containing IUDs, 134, 136t, 138t–140t, 141–142
corpus callosum, agenesis of, 154
corticosteroids
antenatal, in managing preterm birth, 81–82, 97, 157
for hyperemesis, 96
and hyperglycemia, 81–82, 96, 97
cortisol, 63, 76, 80
counseling
contraceptive, 3, 9, 135, 145
genetic, 109, 110
prepregnancy, 2–3, 8, 9–11, 18
C-peptide levels, 57
craniofacial defects, congenital, 155
creatinine, serum levels of, 12
crown-rump length, 111
CSII. See continuous subcutaneous insulin infusion
CVS. See chorionic villus sampling
D
daily food logs, 36
daily glucose patterns, 55, 56f
dawn phenomenon, 17
degludec (insulin degludec), 18t, 77–78, 78t
dehydration, 66t, 94, 96
delivery
birth injury during, 30, 117, 155–156
cesarean, 30, 82, 83t, 106, 116–118, 144
estimated date of, 111–112
fetal monitoring during, 117, 156
glycemic control during, 82, 83t, 117–118
mode of, 116–118
neonatal concerns and care in, 149
neonatal resuscitation in, 161–162, 162t
postpartum care after, 123–125
preterm, 81–82, 97
timing of, 100, 106, 116–118, 116t
Depo-Provera (DMPA injection), 136t, 138t–140t, 143–144
depression, 9, 34, 124
desogestrel, 143
detemir (insulin detemir), 16–17, 18t, 77–78, 96
dexamethasone, 81–82
dextrose, for neonatal hypoglycemia, 159
DHA (docosahexaenoic acid), 43
diabetes. See also specific types and topics
complications in, 91–103
contraindications to pregnancy in, 10, 13, 13t
hereditary risk of, 10
medications for, 73–89 (See also insulin; specific medications)
neonatal risks and outcomes in, 151–152 (See also neonatal care)
screening for, 57–58, 59t
unrecognized, in pregnancy, 57, 93
diabetes educators, 9, 14, 17, 35
diabetic ketoacidosis (DKA), 66, 98–99
antenatal corticosteroids and, 97
CSII and risk of, 17
hyperemesis and, 96
laboratory findings in, 66t, 99
nonreassuring fetal heart rate in, 99
risk factors for, 98
signs and symptoms of, 66t
diagnostic testing, 106, 107, 107t–108t. See also specific types
diet and nutrition
breastfeeding and, 33t–34t, 35t, 126–129, 126t, 127t
in hyperemesis, 94–95, 95t
postpartum, 126–129, 126t, 127t
in pregnancy, 32–47
caloric restriction and, 30–32
carbohydrates in, 38–39
energy (calorie) requirements in, 37–38, 38t
fat in, 42–43
fiber in, 40, 40t–41t
folate in, 44
food safety and, 45–47
for gestational diabetes, 34
glycemic index and, 42
high-amylose foods in, 42
iron in, 44
macronutrients in, 37–43
meal planning and recordkeeping in, 27, 35–37, 35t, 36t
micronutrients in, 43–45
for preexisting diabetes, 32
protein in, 42
resistant starches in, 42
sodium in, 43–44
vitamin and mineral supplementation in, 45
vitamin D and calcium in, 44–45
prepregnancy, 14–15, 14t
dietary fat, 60
and glucose monitoring, 60
in postpartum nutrition, 128
in pregnancy, 37, 42–43
in prepregnancy nutrition, 15
dietary fiber, 37, 40, 40t–41t, 42
Dietary Guidelines for Americans, 15, 43, 45, 47
Dietary Reference Intakes (DRIs), 14, 27, 32, 33t–34t, 37, 45, 126, 127t
dietitian, 9, 14, 32, 34, 35, 37, 128
dimenhydrinate, 95
diphenhydramine, 95
DKA. See diabetic ketoacidosis
DMPA injection, 136t, 138t–140t, 143–144
DNA methylation, 153
DNA testing, cell-free fetal, 106, 108t, 110
docosahexaenoic acid (DHA), 43
Doppler velocimetry, 108t, 113, 115
dosing, insulin, 78, 79f, 79t
Down syndrome, 109
doxylamine, 95
DRIs. See Dietary Reference Intakes drospirenone, 143
due date, estimated, 111–112
E
early delivery, 116
echocardiography, fetal, 154 education, patient. See also counseling
on diabetic ketoacidosis, 66
on hypoglycemia, 17
on insulin (insulin therapy), 15–16
on self-monitoring of blood
glucose, 16
eicosapentaenoic acid, 43
empty stomach, avoiding, 94
energy (calorie) requirements
in pregnancy, 37–38, 38t
prepregnancy, 14, 14t
epigenetics, 163
Erb palsy, 156
essential fatty acids, 43, 128
Essure, 144
estimated due date, 111
estriol, 109
estrogen, 76, 137
estrogen-containing contraceptives, 134, 136t, 137
estrogen/progestin contraceptives, 136t, 137, 142–143
etonogestrel, 143
exercise
and glucose levels, 47, 63–64
as treatment modality, 17, 47
eye examination, prepregnancy, 12–13
F
family planning, 3, 9, 134, 135. See also contraception
fasting glucose levels
in pregnancy, 54, 56–57, 61–62
prepregnancy, 16
fat, dietary
and glucose monitoring, 60
in postpartum nutrition, 128
in pregnancy, 37, 42–43
in prepregnancy nutrition, 15
fatty acids, 43, 65, 128
FDA. See Food and Drug Administration
female fetus, and hyperemesis, 93–94
female sterilization, 136t, 144, 145t
femur length, fetal, 112
fetal activity, testing for, 108t
fetal death, 99–100
fetal DNA testing, cell-free, 106, 108t, 110
fetal growth restriction (FGR), 115 fetal heart rate, 99, 106, 113–114, 113f, 114f
fetal hyperinsulinemia, 97, 99, 111
fetal hyperinsulinism, 155
fetal lung maturity, 81–82, 97, 111, 157
fetal movement, 113
fetal surveillance, 99, 106, 107, 113–115
fetal ultrasound, 106, 107t, 111–114, 154
FGR. See fetal growth restriction fiber, dietary, 37, 40, 40t–41t, 42
finger-stick testing, 54, 60
FISH (fluorescence in situ hybridization), 110–111
fluid intake, postpartum, 128
fluorescence in situ hybridization (FISH), 110–111
folate (folic acid), 6, 15, 44
follow-up
in gestational diabetes, 19, 124
in neonatal care, 162–163
Food and Drug Administration (FDA), 16, 18t, 77, 144, 158
foodborne illness, 46–47
food safety, 45–47
forearm, as testing site, 60
fructosamine, 65
G
gastric emptying, 60
gastroenteropathy, 10, 13
gastrointestinal defects, congenital, 155
gastroparesis, 93–96
GDM. See gestational diabetes mellitus
genetic counseling, 109, 110
genetic screening and testing, 106, 108t, 109–111
genitourinary defects, congenital, 155
gestational age, 111–112, 149
gestational diabetes mellitus (GDM)
antenatal testing in, 115
caloric restriction and, 31
contraceptive options after, 134, 137, 138t–140t
delivery timing and mode in, 106, 116–118
exercise as treatment modality in, 48
expectant management of, 117
gestational diabetes mellitus (GDM) (continued)
follow-up in, 19, 124
insulin for, 74, 77–82
metabolic changes of pregnancy and, 76
neonatal risks and outcomes in, 151–152 (See also neonatal care)
nutritional management in, 34
one-step approach for, 58, 59t
oral antidiabetes medications for, 74, 83–84
postpartum diabetes with, 18–19, 122, 124
postpartum management of, 122, 123–124
previous, 3, 18–19
screening and diagnosis of, 58, 59t
two-step approach for, 58, 59t
weight loss and reducing risk of, 19
gestodene, 143
GI. See glycemic index
glargine (insulin glargine), 16, 18t, 77–78, 78t, 96
GLP-1 (glucagon-like peptide 1) agonists, 82, 83
glucagon, 17, 81
glucagon-like peptide 1 (GLP-1) agonists, 82, 83
gluconeogenesis, hepatic, 47, 77, 84
glucose levels. See also hyperglycemia; hypoglycemia
breastfeeding and, 125–126
exercise and, 47, 63–64
factors affecting, 63–64
fasting, 16, 54, 56–57, 61–62
goals in pregnancy, 54, 56–57
interstitial tissue, 54, 61–62
intrapartum, 82, 83t, 117–118
nocturnal, 16, 63
normoglycemia
in gestational diabetes, 34
in pregnancy, 54, 55–57
patterns in pregnancy
across gestation, 55, 56f
daily, 55, 56f
postprandial, 16, 37, 39, 42, 54, 56–57, 61–62
prepregnancy management of, 15–17, 15t
testing (See glucose monitoring)
glucose monitoring
ambulatory glucose profiles, 62
breastfeeding and, 126
continuous, 54, 61–62, 62t, 80–81
postpartum, 122, 124, 126
in pregnancy, 59–62, 80–81
prepregnancy, 16
self-monitoring, 59–61 (See also self-monitoring of blood glucose)
glucose tolerance test (GTT), postpartum, 124
glulisine (insulin glulisine), 18t glyburide, 74, 83–84
glycated hemoglobin, 64–65. See also A1C
glycated serum protein assays, 65
glycemic control. See also glucose levels
diet and, 37, 38–39
intrapartum, 82, 83t
and neonatal risks and outcomes, 151–152
in pregnancy, 53–72
goals and targets for, 54, 56–57, 62, 63t
insulin regimens for, 77–82
metabolic changes and, 75–77
oral antidiabetes medications for, 74, 83–84
prepregnancy, 15–17, 15t
glycemic index (GI), 40, 42, 60
glycogen, 155, 159
growth restriction, fetal/intrauterine, 115, 156
GTT. See glucose tolerance test gynecologic examination,
prepregnancy, 13
H
hamartomas, 154
Harris-Benedict equation, 31
hCG (human chorionic gonadotropin), 93, 109
head circumference, fetal, 112 healthcare team, 9, 27, 32
health risks, in offspring, 6t, 162–163
heart defects, congenital, 154, 155
heart disease
as contraindication to pregnancy, 10, 13
prepregnancy assessment for, 13
heart rate, fetal, 99, 106, 113–114, 113f
hemoglobin, glycated, 64–65. See also A1C
hemoglobinopathies, 64–65, 65t
hepatic gluconeogenesis, 47, 77, 84
herbal medicines and supplements, 46
high-amylose foods, 42
hirsutism, 143
history, prepregnancy, 11
holoprosencephaly, 154
hormonal contraceptives, 134, 137–144
contraindications to, 137
efficacy of, 136t
risks/risk categories of, 137, 138t–140t
hormones, contra-insulin, 63, 76
hospitalization
for hyperemesis, 96
for postpartum problems, 124
HPL. See human placental lactogen
human chorionic gonadotropin (hCG), 93, 109
human (regular) insulin, 16, 18t, 61, 78, 78t, 81
human placental lactogen (HPL), 63, 76, 125
hyaline membrane disease, 111, 157
hydrocephalus, 154
β-hydroxybutyrate, 31, 160
β-hydroxybutyric acid, 66
hyperbilirubinemia, neonatal, 160–161
hyperemesis, 92, 93–96
etiology of, 93–94
hospitalization for, 96
insulin adjustments in, 96
nonpharmacologic treatment of, 94–95, 95t
onset of, 94
pharmacologic treatment of, 95–96
hyperemesis gravidarum, 93–94
hyperglycemia
breastfeeding and, 126
diet and, 37
intrapartum, 82
obstetric management and, 81–82
steroids and, 81–82, 96, 97
tocolytic agents and, 82, 97
Hyperglycemia and Adverse
Pregnancy Outcomes (HAPO) study, 57
hyperinsulinemia, fetal, 97, 99, 111
hyperinsulinism, fetal, 155
hypertension
preeclampsia, 12, 98, 124
prepregnancy assessment for, 12
and retinopathy, 13
risk, in offspring, 163
hypertrophic cardiomyopathy, neonatal, 155
hypocalcemia, neonatal, 159–160
hypoglycemia, 81
breastfeeding and, 82, 126
daytime, 16
diet and, 37
hyperemesis and, 96
neonatal, 123, 151, 157–159
nocturnal, 16–17, 39, 63, 78, 80, 126
postpartum medications and, 122
hypomagnesemia, neonatal, 159–160
hypospadias, 155
hypoxia, neonatal, 155–156
I
imperforate anus, 155
implants, contraceptive, 134, 136t, 138t–140t, 142, 142, 143
indomethacin, 97
induction of labor
fetal heart rate in, 114
insulin management for, 82, 83t
infants (neonates), 149–173. See also specific neonatal disorders
evaluation of, 149, 155, 161
hypoglycemia in, 123, 151, 157–159
long-term follow-up of, 162–163
neurodevelopmental outcomes of, 158, 163–164
infants (neonates) (continued)
nursery care for, 161, 161t
postpartum care and, 123–125
resuscitation of, 161–162, 162t
risks and outcomes of, diabetes in
birthing parent and, 151–152
skin-to-skin contact with, 123
inhaled human insulin, 18t
injectable contraceptives, 134, 135, 143–144
Institute of Medicine (IOM)
nutrition recommendations of, 14, 27, 32, 33t–34t, 37, 39, 45
weight gain recommendations of, 29–32, 29t
insulin (endogenous)
basal stage of, 77–78
in breast milk, 82
meal stage of, 77, 78
metabolic changes of pregnancy and, 75–77
insulin (insulin therapy)
aspart, 16, 18t, 78, 78t
breastfeeding and, 126
detemir, 16–17, 18t, 77–78, 96
FDA-approved for pregnancy, 16–17, 18t
glargine, 16, 18t, 77–78, 78t, 96
glulisine, 18t
hyperemesis and, 96
intermediate-acting, 16, 77–78, 78t
intrapartum, 82, 83t, 117–118
lispro, 16, 18t, 78, 78t
long-acting, 16–17, 77–78, 78t, 96
NPH, 16–17, 18t, 77–78, 78t
pharmacokinetics of, 61
postpartum, 82, 122, 123–124
pregnancy regimen of, 77–82
continuous subcutaneous infusion, 74, 79–80
dose for, 78, 79f, 79t
for gestational diabetes, 74
human versus analogs, 77
hypoglycemia in, 81
metabolic changes and, 75–77, 76f
multiple daily injections, 77–78
obstetric considerations in, 81–82
for preexisting diabetes, 74
treatment goal of, 77
premixed, 74
prepregnancy regimen of, 15–17, 15t
rapid-acting, 16, 17, 61, 78, 78t, 96
regular, 16, 18t, 61, 78, 78t, 81
ultra-long-acting, 77–78, 78t
insulin-like growth factor (IGF), and neonatal cardiomyopathy, 155
insulin pump. See continuous subcutaneous insulin infusion
insulin resistance, metabolic changes of pregnancy and, 75–77
integrated screen, 108t, 109–110
intensive insulin therapy, prepregnancy, 15–17
intermediate-acting insulin, 16, 77–78, 78t
intermittently scanned continuous glucose monitoring (isCGM), 61
interstitial glucose levels, 54, 61–62
intestinal atresia, 155
intrapartum glycemic control, 82, 83t, 117–118
intrapartum monitoring, 117, 156 intrauterine devices (IUDs), 134, 137–142
copper-containing, 134, 136t, 138t–140t
efficacy of, 136t
levonorgestrel-releasing, 134, 136t, 138t–140t, 141–142, 141t, 143
and pelvic inflammatory disease, 141–142
risks/risk categories of, 138t–140t, 142
intrauterine growth restriction (IUGR), 115, 156
IOM. See Institute of Medicine iron, 44, 45, 129
ischemic heart disease, 10, 13 IUDs. See intrauterine devices
K
kangaroo care, 123
karyotyping, 110–111
ketoacidosis. See diabetic ketoacidosis
ketonemia, 66, 94, 128
ketones, 66, 159
ketonuria, 31, 34, 66, 93, 94
kidney defects, congenital, 155
kidney disease
and preeclampsia, 12, 98
pregnancy risks associated with, 13
prepregnancy assessment for, 12
Kyleena, 136t, 141, 141t
L
labetalol, 12
labor. See also delivery
fetal heart rate during, 114, 114f
fetal monitoring during, 117, 156
glycemic control during, 82, 83t, 117–118
preterm, 81–82, 97
lactation. See breastfeeding
lactogen, placental, 63, 76, 125
lactogenesis, 125
lactose, 125
LARCs. See long-acting reversible contraceptives
large for gestational age. See macrosomia
laser photocoagulation, 12
late decelerations, 114, 114f
levonorgestrel-releasing IUDs, 134, 136t, 138t–140t, 141–142, 141t, 143
lifestyle management. See also diet and nutrition; exercise; weight gain; weight loss
in hyperemesis, 94–95, 95t
in pregnancy, 25–52
prepregnancy, 14–15, 14t, 17
Liletta, 136t, 141, 141t
lispro (insulin lispro), 16, 18t, 78, 78t Listeria, 46–47
liver, gluconeogenesis in, 47, 77, 84 liver function tests, 93
long-acting insulin, 16–17, 77–78, 78t, 96
long-acting reversible contraceptives (LARCs), 135, 136t, 137–142
long-term follow-up, in neonatal care, 162–163
lung maturity, fetal, 81–82, 97, 111, 157
M
macronutrients
for postpartum nutrition, 128
for pregnancy, 37–43
macrosomia, 30, 31, 32, 155–156
glucose levels and, 61–62
overgrowth pattern in, 156
timing and mode of delivery in, 116
ultrasound screening for, 112, 115
macular edema, 12
magnesium
low levels in neonate, 159–160
nutritional requirements for, 45
in tocolysis, 97
magnesium sulfate, 98
male sterilization, 136t, 144, 145t
Managing Diabetes and Pregnancy (Kitzmiller et al), 39
mastitis, 125–126
maternal commitment, to pregnancy, 10
maternal complications, 5, 5t. See also specific complications
maternal serum AFP (MSAFP), 106, 108t, 109
MDIs. See multiple daily injections
meal plan
pregnancy and lactation, 27, 35–37, 35t
prepregnancy, 14–15
meal stage, of insulin secretion, 77, 78
MEC. See Medical Eligibility Criteria meclizine, 95
Medical Eligibility Criteria (MEC), 137, 138t–140t
medical nutrition therapy (MNT)
for gestational diabetes, 34
postpartum, 126–129
for preexisting diabetes, 32
in pregnancy, 27
medications. See also insulin; specific medications
antiemetic, 95–96
for diabetes in pregnancy, 73–89
mercury, 47, 128
metabolic changes, in pregnancy, 55, 75–77, 76f
metabolic control. See also glycemic control
alternative measures of, 64–65
metabolic syndrome, risk in offspring, 162–163
metformin, 74, 82, 83–84, 124
methyldopa, 12
methylprednisolone, 96
metoclopramide, 96 micronutrients
in postpartum nutrition, 129
in pregnancy, 43–45
mineral supplementation, 45
Mirena, 136t, 141, 141t
miscarriage, 6–8, 10, 76, 99–100
MNT. See medical nutrition therapy mode of delivery, 116–118. See also cesarean delivery
modified biophysical profile, 99, 114
molar pregnancy, 93
MOM (multiples of the median), 109
monounsaturated fats, 43
morning dose, 16, 81
morning glucose intolerance, 63
morning sickness, 93. See also
hyperemesis multidisciplinary team, 9, 27, 32
multiple daily injections (MDIs)
in pregnancy, 77–78
prepregnancy, 15–17
multiple-marker screening, 108t, 109–110
multiples of the median (MOM), 109
musculoskeletal anomalies, 154
N
National Glycohemoglobin Standardization Program (NGSP), 64
National Health and Nutrition Examination Survey (NHANES), 93
nausea. See hyperemesis neonatal care, 149–173
evaluation in, 149, 155, 161
long-term follow-up in, 162–163
neurodevelopmental outcomes in, 158, 163–164
nursery care in, 161, 161t
postpartum, 123–125
risks and outcomes in, diabetes in birthing parent and, 151–152
skin-to-skin contact in, 123
neonatal hyperbilirubinemia, 160–161
neonatal hypocalcemia, 159–160
neonatal hypoglycemia, 123, 151, 157–159
definition of, 158
management for, 159
neurodevelopmental effects of, 158
pathogenesis of, 157
screening for, 158
signs of, 159
neonatal hypomagnesemia, 159–160
neonatal polycythemia, 160–161
neonatal resuscitation, 161–162, 162t
neonatal small left colon syndrome, 155
neonatologist, 9, 152
nephrologist, 9
neural tube defects, 154
neurodevelopmental outcomes, 158, 163–164
Nexplanon, 136t, 142
nifedipine, 12
nocturnal hypoglycemia, 16–17, 39, 63, 78, 80, 126
nonreassuring fetal heart, 99, 114, 114f
nonstress test (NST), 99, 113–114, 113f
norethindrone, 143, 144 normoglycemia
in gestational diabetes, 34
in pregnancy, 54, 55–57
Norplant, 143
NPH insulin, 16–17, 18t, 77–78, 78t
NST. See nonstress test
nuchal translucency, 108t, 112
nursery care, 161, 161t
nurses, 9
nutrition. See diet and nutrition
nutritionist, 32, 34, 37, 128
NuvaRing, 136t, 137
O
obesity
caloric restriction for, 30–32
congenital anomaly risk in, 6
GDM risk in, 19, 151
pregnancy weight gain in, 29, 30–32
prepregnancy, 14, 19
risk, in offspring, 162–163
obstetrician, 9
obstructive uropathy, 155
offspring, diabetes and risks to, 6t, 162–163
olanzapine, 96
oligohydramnios, 113–114
omega-3 fatty acids, 43, 128
omega-6 fatty acids, 43, 128
ondansetron, 95–96
one-step approach, for GDM, 58, 59t
ophthalmologist, 9
oral antidiabetes medications
and breastfeeding, 82
in pregnancy, 74, 83–84
oral contraceptives, 134, 135, 137, 142–144
efficacy of, 136t
risks/risk categories of, 138t–140t, 142
organogenesis, 7, 10, 15, 75, 96, 112, 153
oxidative stress, 7, 153, 157
oxytocin, 114
P
palm, as testing site, 60
pancreatic secretion, of insulin, 77–78
patch, contraceptive, 134, 136t, 137, 142
patient education. See also counseling
on diabetic ketoacidosis, 66
on hypoglycemia, 17
on insulin (insulin therapy), 15–16
on self-monitoring of blood
glucose, 16
Pediatric Endocrine Society (PES), 159
pediatrician, 9
pelvic inflammatory disease (PID), IUDs and, 141–142
perinatal deaths, 99–100
permanent sterilization, 134, 135, 136t, 144, 145t
physical activity. See exercise physical examination, prepregnancy, 12
placenta
biopsy of, 110
delivery of, 76, 123
development and function of, 75–76
medications crossing/not crossing, 15, 16, 74, 84
vascular resistance of, 155
placental lactogen, 63, 76, 125
polycythemia, neonatal, 160–161
polyhydramnios, 112
polyunsaturated fats, 43
postpartum care, 123–125
postpartum concerns, 121–132. See also specific concerns
postpartum diabetes
GDM and risk of, 18–19, 122, 124
testing for, 124
postpartum glucose monitoring, 122, 124, 126
postpartum insulin, 82, 122, 123–124 postpartum nutrition, 126–129, 126t, 127t
postpartum thyroiditis, 125
postpartum weight, 122, 128 postprandial glucose levels
in pregnancy, 37, 39, 42, 54, 56–57, 61–62
prepregnancy, 16
potassium, 34t, 45
prediabetes, 3, 19, 122, 124, 137
predinner dosing, 16
preeclampsia, 12, 98, 124
preexisting diabetes, 5–8
congenital anomalies in, 6–8, 7t, 8t, 10, 99–100
contraindications to pregnancy in, 13, 13t
exercise as treatment modality in, 17, 48
preexisting diabetes (continued)
general guidelines for, 2–3
maternal complications in, 5, 5t
neonatal risks and outcomes in, 151–152 (See also neonatal care)
nutritional management for, 32
offspring complications in, 6t, 162–163
pregnancy insulin regimen in, 74, 77–82
prepregnancy assessment in, 11–14, 11t
prepregnancy counseling in, 2–3, 8, 9–11
prepregnancy insulin regimen in, 15–17, 15t
prepregnancy management in, 2–3, 14–17
risk factors for, 57, 57t
unrecognized, 57
pregnancy. See also specific topics
contraindications to, 10, 13, 13t
ketogenesis in, 65
metabolic changes in, 55, 75–77, 76f
molar, 93
preventing (See contraception) pregnancy loss, 6–8, 10, 76, 99–100
pregnancy (family) planning, 3, 9, 134, 135. See also contraception premature birth, inadequate weight
gain and, 30
premixed insulins, 74
prenatal care
diabetes screening in, 57–58, 59t
surveillance and testing in, 105–119, 107t–108t
prenatal vitamins, 45, 94, 129
prepregnancy assessment, 11–14, 11t
prepregnancy counseling, 9–11, 18
general guidelines for, 2–3
goals of, 9t
for those planning pregnancy, 9–11
for those wanting to delay
pregnancy, 9–10
as vital component of care, 8
prepregnancy management, 2–3, 14–17
preterm birth, 81–82, 97
prochlorperazine, 95
progesterone, 63, 76, 137
progestin-only contraceptives, 134, 143–144
efficacy of, 136t
risks/risk categories of, 138t–140t
prolactin, 76, 125
promethazine, 95
protein, dietary, 37, 60
in postpartum nutrition, 128
in pregnancy, 42
protein serum concentrations, 65
protein-to-creatinine ratio, 12
proteinuria, 98
pyridoxine, 95
R
rapid-acting insulin, 16, 17, 61, 78, 78t, 96
RDS. See respiratory distress syndrome
real-time continuous glucose monitoring (rtCGM), 61
reassurance, 11
regular (human) insulin, 16, 18t, 61, 78, 78t, 81
renal agenesis/hypoplasia, 155
renal disease. See kidney disease
resistant starches, 42
respiratory distress, neonatal, 157
respiratory distress syndrome (RDS), 111, 151, 157
resuscitation, neonatal, 161–162, 162t
retinopathy
prepregnancy assessment for, 12
progression during pregnancy, 10, 12–13
risk assessment, 106–119.See also specific screening and testing
ritodrine, 82, 97
S
SAB. See spontaneous abortion
salpingectomy, 144, 145t
saturated fats, 15, 43
schizencephaly, 154
screening, 106–115, 107t–108t
for congenital anomalies, 106, 108t, 109–110, 112, 154
for diabetes, 57–58, 59t
genetic, 106, 108t, 109–111
for neonatal hypoglycemia, 158
seafood, 43, 44, 47, 128 seizures
hypoglycemia and, 81
neonatal, 159, 160
preeclampsia and, 98
selenium, 45
self-monitoring of blood glucose (SMBG)
breastfeeding and, 126
insulin pharmacokinetics and, 61
nutrition and, 32, 37, 39
postpartum, 124
in pregnancy, 54, 59–61, 80–81
prepregnancy, 16
site of, 60
timing of, 61–62
self-monitoring of uterine activity, 47
sequential screen, 109–110
SGA. See small-for-gestational age
shoulder dystocia, 117, 156
skin-to-skin contact, 123
Skyla, 136t, 141, 141t
small-for-gestational age (SGA)
caloric restriction and, 31
inadequate weight gain and, 30
ultrasound screening for, 112
small left colon syndrome, neonatal, 155
SMBG. See self-monitoring of blood glucose
smoking, 2, 17, 137
social worker, 9
sodium-glucose cotransporter 2 (SGLT2) inhibitors, 83
sodium intake, 15, 34t, 43–44
special-care nursery, 161, 161t
spontaneous abortion (SAB), 6–8, 10, 76, 99–100
starches, resistant, 42
sterilization, 134, 135, 136t, 144, 145t
steroids
antenatal, in managing preterm birth, 81–82, 97, 157
for hyperemesis, 96
and hyperglycemia, 81–82, 96, 97
stillbirth, 99–100
surfactant, 157
sweeteners, nonnutritive, 46
sympathomimetics, 82
T
Tanzania, caloric restriction in, 31
Tay–Sachs disease, 109
teratogenicity, 7, 12, 99. See also congenital anomalies
terbutaline, 82, 97
thigh, as testing site, 60
thyroid function tests, 93
thyroiditis, postpartum, 125
time of day
and glucose patterns, 55, 56f
and nocturnal hypoglycemia, 16–17, 39, 63, 78, 80, 126
timing
of antenatal testing, 115
of contraceptive counseling, 145
of delivery, 100, 106, 116–118, 116t
of self-monitoring, 61–62
tocolysis, 82, 97
transdermal contraceptives, 134, 136t, 137, 142
trans fats, 15, 43
transvaginal contraceptives, 134, 135, 136t, 137, 142
Twirla, 136t, 137
two-step approach, for GDM, 58, 59t
type 1 diabetes
breastfeeding and, 125
glycemic targets in, 62, 63t
intrapartum management in, 82
metabolic changes of pregnancy and, 75, 76f
postpartum insulin for, 82, 123–124
pregnancy insulin regimen in, 77–82
type 2 diabetes
diagnostic criteria for, 57, 58t
postpartum, GDM and risk of, 18–19, 122, 124
postpartum insulin for, 82
pregnancy insulin regimen in, 77–82
U
ultra-long-acting insulin, 77–78, 78t
ultrasound, 106, 107t, 111–115, 154
umbilical artery Doppler studies, 115
UNICEF, 125
Unisom Sleep Tabs, 95
unrecognized diabetes, in pregnancy, 57, 93
uterine activity, monitoring of, 47
uterine contractions, and fetal heart rate, 114, 114f
V
vaginal delivery, 116–118
vaginal rings, 134, 136t, 137, 142
Valsalva maneuver, 13
vasectomy, 144, 145t
vegetarians, 44, 129
ventral wall defects, 155
vitamin B6, 95
vitamin B12, 44, 129
vitamin C, 45
vitamin D, 44–45
vitamin supplementation
and hyperemesis, 94
for postpartum nutrition, 129
for pregnancy, 45
vomiting. See hyperemesis
W
water intake, postpartum, 128
weight, birth. See also macrosomia
caloric restriction and, 31
glucose levels and, 57
weight gain, 27, 29–32, 29t
weight loss
postpartum, 122, 128
during pregnancy, 14, 19
World Health Organization, 125, 141
X
Xulane, 136t, 137
Z
zinc, 45
