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complicated by type 1 diabetes by show-\ning a mild improvement in A1C and asignifi cant improvement in the maternal\ng l u c o s et i m ei nr a n g e( T I R ) ,w i t h o u ta nincrease in hypoglycemia, and reductions\nin large-for-gestational-age births, length\nof infant hospital stays, and severeneonatal hypoglycemia... | [
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vational cohort study that evaluated\nthe glycemic variables reported using\nCGM systems found that lower mean\nglucose, lower standard deviation, and ahigher percentage of time in range were\nassociated with lower risks of large-for-\ngestational-age births and other adverse\nneonatal outcomes (50). Data from one | [
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neonatal outcomes (50). Data from one\nstudy suggest that the use of the CGM-reported mean glucose is superior to the\nuse of estimated A1C, glucose manage-\nment indicator, and other calculations to\nestimate A1C, given the changes to\nA1C that occur in pregnancy (51). CGMTIR can be used for assessment of gly-\ncemic ... | [
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cemic outcomes in people with type 1\ndiabetes, but it does not provide action-\nable data to address fasting and post-\nprandial hypoglycemia or hyperglycemia.The cost of CGM in pregnancies compli-\ncated by type 1 diabetes is offset by im-\nproved maternal and neonatal outcomes\n(52).\nThere are insuf ficient data to ... | [
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(52).\nThere are insuf ficient data to support\nthe use of CGM in all people with type 2\ndiabetes or GDM (53,54). The decision of\nwhether to use CGM in pregnantindividuals with type 2 diabetes or GDM\nshould be individualized based on treat-\nment regimen, circumstances, preferen-ces, and needs.\nThe international con... | [
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The international consensus on TIR\n(37) endorses pregnancy target rangesand goals for TIR for people with type 1diabetes using CGM as reported on the\nambulatory glucose pro file; however, it\ndoes not specify the type or accuracy of | [
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does not specify the type or accuracy of\nthe device or need for alarms and alerts.A prospective, observational study in-cluding 20 pregnant people with type 1diabetes simultaneously monitored with\nintermittently scanning CGM (isCGM) and | [
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intermittently scanning CGM (isCGM) and\nreal-time CGM (rtCGM) for 7 days inearly pregnancy demonstrated a higherpercentage of time-below-range in theisCGM group. Asymptomatic hypoglyce-\nmia measured by isCGM should therefore | [
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mia measured by isCGM should therefore\nnot necessarily lead to a reduction of in-sulin dose and/or increased carbohydrateintake at bedtime unless these episodesare con firmed by blood glucose meter\nmeasurements (55). Selection of CGM\ndevice should be based on an individual ’s\ncircumstances, preferences, and needs. | [
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circumstances, preferences, and needs.\n\x81Target sensor glucose range 63 –140 mg/dL\n(3.5–7.8 mmol/L): TIR, goal >70%\n\x81Time below range ( <63 mg/dL [ <3.5\nmmol/L]): level 1 TBR, goal <4%\n\x81Time below range ( <54 mg/dL [ <3.0\nmmol/L]): level 2 TBR, goal <1%\n\x81Time above range ( >140 mg/dL [ >7.8\nmmol/L]):... | [
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\x81Time above range ( >140 mg/dL [ >7.8\nmmol/L]): TAR, goal <25%\nThe international consensus on TIR\n(37) endorsed the same sensor glucose\ntarget ranges for individuals with type 2\ndiabetes in pregnancy and GDM butcould not quantify the goal of amountof time spent within each category be-cause of insuf ficient data... | [
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MANAGEMENT OF GESTATIONAL\nDIABETES MELLITUS\nRecommendations\n15.14 L i f e s t y l eb e h a v i o rc h a n g ei sa n\nessential component of management\nof gestational diabetes mellitus (GDM)\nand may suffi ce as treatment for many\nindividuals. Insulin should be added if\nneeded to achieve glycemic goals. A\n15.15 In... | [
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15.15 Insulin is the preferred medica-\ntion for treating hyperglycemia inGDM. Metformin and glyburide, indi-\nvidually or in combination, should not\nbe used as first-line agents, as bothcross the placenta to the fetus. A\nOther oral and noninsulin injectable\nglucose-lowering medications lack long-term safety data. E | [
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glucose-lowering medications lack long-term safety data. E\n15.16 Metformin, when used to treat\npolycystic ovary syndrome and induceovulation, should be discontinued bythe end of the first trimester. A\n15.17 Telehealth visits used in combi- | [
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15.17 Telehealth visits used in combi-\nnation with in-person visits for preg-nant people with GDM can improveoutcomes compared with standard in-person care alone. A\nGDM is characterized by an increased risk | [
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of large-for-gestational-age birth weightand neonatal and pregnancy complica-tions and an increased risk of long-termmaternal type 2 diabetes and abnormalglucose metabolism of offspring in child-hood. These associations with maternaloral glucose tolerance test (OGTT) resultsare continuous with no clear in flection | [
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points (39,56). Offspring with exposureto untreated GDM have reduced insulinsensitivity and b-cell compensation and\nare more likely to have impaired glucosetolerance in childhood (57). In other words,short-term and long-term risks increasewith progressive maternal hyperglycemia.Therefore, all pregnant people should | [
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be screened as outlined in Section 2,\n“Diagnosis and Classi fication of Diabetes. ”\nAlthough there is some heterogeneity,many RCTs and a Cochrane review suggestthat the risk of GDM may be reduced bydiet, exercise, and lifestyle counseling, par-ticularly when interventions are startedduring the first or early in the sec... | [
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mester (58 –60). There are no intervention | [
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trials in offspring of mothers with GDM. Am e t a - a n a l y s i so f1 1R C T sd e m o n s t r a t e dthat metformin treatment in pregnancydoes not reduce the risk of GDM in high-risk individuals with obesity, polycystic ovarysyndrome, or preexisting insulin resistance(61). A meta-analysis of 32 RCTs evaluatingthe eff... | [
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meta-analysis of 32 RCTs evaluatingthe effectiveness of telemedicine interven-tions, which ranged from telemedicine visits | [
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to the use of health apps, used in combina- | [
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tion with in-person visits for GDM demon-strated reduced incidences of cesareandelivery, premature rupture of membranes,pregnancy-induced hypertension or pre-eclampsia, preterm birth, neonatal asphyxia,and polyhydramnios compared with stan-dard in-person care alone (62).S286 Management of Diabetes in Pregnancy Diabetes... | [
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of Diabetes in Pregnancy Diabetes Care Volume 47, Supplement 1, January 2024 | [
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©AmericanDiabetesAssociation | [
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Lifestyle and Behavioral Management\nAfter diagnosis, treatment starts with\nmedical nutrition therapy, physical activ-ity, and weight management, dependingon pregestational weight, as outlined in\nthe section below on preexisting type 2 | [
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the section below on preexisting type 2\ndiabetes, as well as glucose monitoringaiming for the goals recommended by theFifth International Workshop-Conference\non Gestational Diabetes Mellitus (63):\n\x81Fasting glucose <95 mg/dL ( <5.3 mmol/L)\nand either\n\x81One-hour postprandial glucose <140\nmg/dL ( <7.8 mmol/L) o... | [
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mg/dL ( <7.8 mmol/L) or\n\x81Two-hour postprandial glucose <120\nmg/dL ( <6.7 mmol/L)\nThe glycemic goal lower limits de fined\nabove for preexisting diabetes apply for\nGDM treated with insulin. Dependingon the population, studies suggest that70–85% of people diagnosed with GDM\nunder Carpenter-Coustan criteria can\nma... | [
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manage GDM with lifestyle modi fication\nalone; it is anticipated that this propor-\ntion will be even higher if the lower In-ternational Association of the Diabetes\nand Pregnancy Study Groups (64) diag-\nnostic thresholds are used.\nMedical Nutrition Therapy | [
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nostic thresholds are used.\nMedical Nutrition Therapy\nMedical nutrition therapy for GDM is anindividualized nutrition plan developedbetween the pregnant person and an\nRDN familiar with the management of | [
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RDN familiar with the management of\nGDM (65,66). The food plan shouldprovide adequate calorie intake to pro-mote fetal/neonatal and maternal health,achieve glycemic goals, and promote ap-\npropriate weight gain, according to the\n2009 National Academy of Medicine rec-ommendations (67). There is no de finitive | [
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research that identi fies a speci fic optimal\ncalorie intake for people with GDM orsuggests that their calorie needs are dif-ferent from those of pregnant individualswithout GDM. The food plan should bebased on a nutrition assessment with di-\netary reference intake guidance from | [
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etary reference intake guidance from\nthe National Academy of Medicine.The recommended dietary referenceintake for all pregnant people is a mini-\nmum of 175 g of carbohydrate ( /C2435% of\na 2,000-calorie diet), a minimum of 71 g\nof protein, and 28 g of fiber (68). The nu-\ntrition plan should emphasize monoun-\nsatur... | [
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saturated and polyunsaturated fats while\nlimiting saturated fats and avoiding trans\nfats. As is true for all nutrition therapy inpeople with diabetes, the amount and | [
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type of carbohydrate will impactglucose levels. Promoting higher-quality,nutrient-dense carbohydrates results incontrolled fasting/postprandial glucose,lower free fatty acids, improved insulinaction, and vascular benefi ts and may re- | [
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-0... |
duce excess infant adiposity. Individualswho substitute fat for carbohydrates mayunintentionally enhance lipolysis, promoteelevated free fatty acids, and worsen ma-ternal insulin resistance (69,70). Fastingu r i n ek e t o n et e s t i n gm a yb eu s e f u lt oidentify those who are severely restrict-ing carbohydrates ... | [
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who are severely restrict-ing carbohydrates to manage blood glu-cose. Simple carbohydrates will result inhigher postmeal excursions. | [
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Physical Activity\nA systematic review demonstrated im-provements in glucose outcomes and re-ductions in need to start insulin or insulindose requirements with an exercise inter-vention. There was heterogeneity in thetypes of effective exercise (aerobic, resis-tance, or both) and duration of exercise(20–50 min/day, 2 –... | [
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erate intensity) (71).\nPharmacologic Therapy\nTreatment of GDM with lifestyle and in-sulin has been demonstrated to im-prove perinatal outcomes in two largerandomized studies, as summarized in aU.S. Preventive Services Task Force re-view (72). Insulin is the first-line agent | [
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recommended for the treatment ofGDM in the U.S. While individual RCTssupport limited ef ficacy of metformin\n(73,74) and glyburide (75) in reducingglucose levels for the treatment ofGDM, these agents are not recom-mended as the first-line treatment for | [
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GDM because they are known to crossthe placenta and data on long-termsafety for offspring is of some concern(35). Furthermore, in separate RCTs, gly-buride and metformin failed to provideadequate glycemic outcomes in 23%\nand 25 –28% of participants with GDM,\nrespectively (76,77).\nSulfonylureas\nSulfonylureas are kno... | [
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Sulfonylureas\nSulfonylureas are known to cross the\nplacenta and have been associated withincreased neonatal hypoglycemia. Con-centrations of glyburide in umbilical cordplasma are approximately 50 –70% of\nmaternal levels (76,77). In meta-analysesand systematic reviews, glyburide was | [
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0.0058... |
associated with a higher rate of neonatalhypoglycemia, macrosomia, and increasedneonatal abdominal circumference thaninsulin or metformin (78,79).\nGlyburide failed to be found noninfe-\nrior to insulin based on a compositeoutcome of neonatal hypoglycemia, mac-rosomia, and hyperbilirubinemia (80).\nLong-term safety dat... | [
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Long-term safety data for offspring ex-\nposed to glyburide are not available (80).\nMetformin\nMetformin was associated with a lowerrisk of neonatal hypoglycemia and less\nmaternal weight gain than insulin in sys-\ntematic reviews and RCTs (78,81 –83). | [
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tematic reviews and RCTs (78,81 –83).\nHowever, metformin readily crosses theplacenta, resulting in umbilical cordblood levels of metformin as high or\nhigher than simultaneous maternal lev-\nels (84,85). In the Metformin in Gesta-tional Diabetes: The Offspring Follow-Up (MiG TOFU) study ’sa n a l y s e so f7 -t o | [
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... |
9-year-old offspring, the 9-year-old off-spring exposed to metformin for thetreatment of GDM in the Auckland co-hort were heavier and had a higher\nwaist-to-height ratio and waist circum-\nference than those exposed to insulin(86). This difference was not found inthe Adelaide cohort. In one RCT of met-\nformin use in p... | [
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formin use in pregnancy for polycystic\novary syndrome, follow-up of 4-year-oldoffspring demonstrated higher BMI andincreased obesity in the offspring ex-\nposed to metformin (87). A follow-up\nstudy at 5 –10 years showed that the\noffspring had higher BMI, weight-to-height ratios, waist circumferences,\nand a borderli... | [
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0.01... |
and a borderline increase in fat mass\n(88,89). A meta-analysis demonstratedthat metformin exposure resulted insmaller neonates with an accelerationof postnatal growth, resulting in higher\nBMI in childhood (88). Follow-up of off-\nspring from the Metformin in Womenwith Type 2 Diabetes in Pregnancy(MiTy Kids) trial sho... | [
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ences in anthropometrics of children\nat 24 months (90).\nRandomized, double-blind, controlled\ntrials comparing metformin with other\ntherapies for ovulation induction in indi-\nviduals with polycystic ovary syndromehave not demonstrated bene fiti np r e -\nventing spontaneous abortion or GDM(91), and there is no evide... | [
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need to continue metformin in these in-\ndividuals (92 –94).diabetesjournals.org/care Management of Diabetes in Pregnancy S287\n©AmericanDiabetesAssociation | [
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There are some people with GDM re-\nquiring medical therapy who may not be\nable to use insulin safely or effectivelyduring pregnancy due to cost, languagebarriers, comprehension, or cultural in-fluences. Oral agents may be an alterna- | [
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tive for these individuals after discussingthe known risks and the need for morelong-term safety data in offspring. How-ever, due to the potential for growth re-striction or acidosis in the setting of\nplacental insuf ficiency, metformin should\nn o tb eu s e di np r e g n a n tp e o p l ew i t hh y - | [
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... |
n o tb eu s e di np r e g n a n tp e o p l ew i t hh y -\npertension or preeclampsia or those atrisk for intrauterine growth restriction(90,95,96).\nInsulin | [
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0.11770721524953842,
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0.021... |
Insulin\nInsulin use should follow the guidelinesbelow. Both multiple daily insulin injec-tions and continuous subcutaneous in-sulin infusion are reasonable deliverystrategies, and neither has been shownto be superior to the other during preg-nancy (97).\nMANAGEMENT OF PREEXISTING\nTYPE 1 DIABETES AND TYPE 2DIABETES IN... | [
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0.07699868828058243,
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TYPE 1 DIABETES AND TYPE 2DIABETES IN PREGNANCY\nRecommendations\n15.18 Insulin should be used to man-\nage type 1 diabetes in pregnancy. A\nInsulin is the preferred agent for the\nmanagement of type 2 diabetes in\npregnancy. B\n15.19 Either multiple daily injections\nor insulin pump technology can be\nused in pregnanc... | [
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0.019228477030992508,
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0.0251163300126791,
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0.0143780... |
used in pregnancy complicated bytype 1 diabetes. C\nThe physiology of pregnancy necessitates | [
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frequent titration of insulin to matchchanging requirements and underscoresthe importance of daily and frequentblood glucose monitoring. Due to thecomplexity of insulin management inpregnancy, referral to a specialized cen-ter offering team-based care (with teammembers including a maternal-fetal med-icine specialist, e... | [
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a maternal-fetal med-icine specialist, endocrinologist or otherhealth care professional experienced in | [
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managing pregnancy and preexisting dia-\nbetes, RDN, diabetes care and educationspecialist, and social worker, as needed) isrecommended if this resource is available.When a single specialized center is notavailable, providing a interprofessionalteam approach through interprofessionalteam members at different centers ma... | [
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still be bene ficial.\nNone of the currently available human\ninsulin preparations have been demon-\nstrated to cross the placenta (93 –98).\nInsulins studied in RCTs are preferred(97,99 –1 0 3 )o v e rt h o s es t u d i e di nc o h o r t\nstudies (104), which are preferred overthose studied in case reports only.\nWhile... | [
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While many health care professionals\nprefer insulin pumps in pregnancy, it isnot clear that they are superior to multi-ple daily injections (105,106). None ofthe current automated insulin delivery\n(AID) systems approved by the U.S. Food | [
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and Drug Administration (FDA) have al-gorithms set to achieve pregnancy goals.It may be appropriate to continue or ini-tiate AID therapy in carefully selectedpregnant individuals with type 1 diabetesin the setting of using assistive techni-ques with expert guidance (107). Assess-ments of potential candidates for AID | [
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wear in pregnancy should include rele- | [
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vant parameters such as glycemic levels,presence or absence of severe hypogly-cemic or hyperglycemic events, ability orcomfort in engaging with diabetes tech-nology, psychosocial determinants, cost,individual preference, and other factors asrelevant. In addition, individuals who useAID systems that do not have pregnanc... | [
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specific glucose targets often benefi tf r o m\nassistive techniques for pump manage- | [
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assistive techniques for pump manage-\nment as determined by expert guidancefrom an experienced interprofessionalteam (107). Partial closed-loop therapy,such as predictive low-glucose suspend(PLGS) technology, has been shown in non-pregnant people to be better than sensor-augmented insulin pumps (SAP) for reduc- | [
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ing low glucose values (108). It may be\nsuited for pregnancy because the predic-tive low-glucose threshold for suspendinginsulin is in the range of premeal and over-night glucose value targets in pregnancyand may allow for more aggressive prandialdosing. See\nSENSOR -AUGMENTED PUMPS and AUTO-\nMATED INSULIN DELIVERY S... | [
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-0.09015633165836334,
-0.0030049... |
MATED INSULIN DELIVERY SYSTEMS in Section 7,\n“Diabetes Technology, ”for more informa-\ntion on these systems.\nType 1 Diabetes\nPregnant individuals with type 1 diabeteshave an increased risk of hypoglycemia inthefirst trimester and, like all pregnant | [
-0.053130846470594406,
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-0.03... |
people, have altered counter-regulatoryresponse in pregnancy that may decreasehypoglycemia awareness. Education forpeople with diabetes and family mem-\nbers about the prevention, recognition, | [
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-0.078442... |
bers about the prevention, recognition,\nand treatment of hypoglycemia is impor-tant before, during, and after pregnancyto help prevent and manage hypoglyce-mia risk. Insulin resistance drops rapidlywith the delivery of the placenta.\nPregnancy is a ketogenic state, and | [
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people with type 1 diabetes, and to alesser extent those with type 2 diabe-tes, are at risk for diabetic ketoacidosis(DKA) at lower blood glucose levelsthan in the nonpregnant state. Pregnantpeople with type 1 diabetes should beadvised to obtain ketone test strips andreceive education on DKA preventionand detection. DK... | [
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0.... |
education on DKA preventionand detection. DKA carries a high risk ofstillbirth. Those in DKA who are unableto eat often require 10% dextrose withan insulin drip to adequately meet thehigher carbohydrate demands of theplacenta and fetus in the third trimesterin order to resolve their ketosis. | [
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Retinopathy is a special concern in | [
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0.0832435... |
pregnancy. The necessary rapid imple-mentation of euglycemia in the setting ofretinopathy is associated with worseningof retinopathy (109). Meta-analyses havealso demonstrated a high risk of new-onset retinopathy and progression of ex-isting retinopathy in pregnant individualswith type 1 or type 2 diabetes (110,111).\n... | [
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Type 2 Diabetes\nType 2 diabetes is often associated withobesity. Recommended weight gain dur-ing pregnancy for people with overweight\nis 15 –25 lb (6.8 –11.3 kg) and for those\nwith obesity is 10 –20 lb (4.5 –9.1 kg)\n(67). There are no adequate data on op-\ntimal weight gain versus weight mainte-nance in pregnant pe... | [
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2; however, losing weight is\nnot recommended because of the in-creased risk of small-for-gestational ageinfants (21).\nOptimal glycemic goals are often easier | [
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to achieve during pregnancy with type 2diabetes than with type 1 diabetes butcan require much higher doses of insulin,sometimes necessitating concentratedinsulin formulations. Insulin is the pre-ferred treatment for type 2 diabetes inpregnancy. An RCT of metformin added toinsulin for the treatment of type 2 diabe-tes f... | [
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... |
for the treatment of type 2 diabe-tes found less maternal weight gain andfewer cesarean births. There were fewermacrosomic neonates, but there wasa doubling of small-for-gestational-ageS288 Management of Diabetes in Pregnancy Diabetes Care Volume 47, Supplement 1, January 2024 | [
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-0.... |
©AmericanDiabetesAssociation | [
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0.0... |
neonates (112). As in type 1 diabetes, insu-\nlin requirements drop dramatically afterdelivery.\nThe risk for associated hypertension\nand other comorbidities may be as highor higher with type 2 diabetes com-\npared with type 1 diabetes, even if dia-\nbetes is better managed and of shorter\napparent duration, with preg... | [
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apparent duration, with pregnancy loss\nappearing to be more prevalent in the\nthird trimester in those with type 2 dia-\nbetes, compared with the first trimester\nin those with type 1 diabetes (113,114).\nPREECLAMPSIA AND ASPIRIN\nRecommendation\n15.20 Pregnant individuals with type 1\nor type 2 diabetes should be pre-... | [
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day starting at 12 to 16 weeks of ges-tation to lower the risk of preeclamp-sia.EA dosage of 162 mg/day may\nbe acceptable; Ecurrently, in the\nU.S., low-dose aspirin is available in81-mg tablets.\nDiabetes in pregnancy is associated withan increased risk of preeclampsia (115).The U.S. Preventive Services Task Force | [
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recommends using low-dose aspirin (81\nmg/day) as a preventive medication at\n12 weeks of gestation in individuals at\nhigh risk for preeclampsia, such as those\nwith type 1 or type 2 diabetes (116).\nHowever, a meta-analysis and an addi-\ntional trial demonstrate that low-dose\naspirin <100 mg is not effective in re- | [
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aspirin <100 mg is not effective in re-\nducing preeclampsia. Low-dose aspirin>100 mg is required (117– 119). A cost-\nbene fit analysis has concluded that\nthis approach would reduce morbidity,save lives, and lower health care costs\n(120). There are insuf ficient data about\nwhether the use of aspirin speci fically | [
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whether the use of aspirin speci fically\nin pregnant people with preexisting dia-\nbetes ultimately reduces the incidence\nof preeclampsia (121,122), although a\nmeta-analysis showed that preeclampsia\nreductions occurred with aspirin adminis-\ntration in high-risk groups overall (115).\nIndividuals with GDM may be can... | [
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Individuals with GDM may be candidates\nfor aspirin therapy for preeclampsia pre-\nvention if they have a single high risk fac-\ntor, such as chronic hypertension or anautoimmune disease, or multiple moder-\nate risk factors, such as being nulliparous,\nhaving obesity, being age $35 years, or | [
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having obesity, being age $35 years, or\nother factors per the U.S. PreventiveS e r v i c e sT a s kF o r c e( 1 1 6 ) .M o r es t u d i e sare needed to assess the long-term ef-\nfects of prenatal aspirin exposure on off-spring (121).\nPREGNANCY AND DRUG\nCONSIDERATIONS\nRecommendations\n15.21 In pregnant individuals ... | [
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Recommendations\n15.21 In pregnant individuals with dia-\nbetes and chronic hypertension, a\nblood pressure threshold of 140/90\nmmHg for initiation or titration of ther- | [
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0.03... |
mmHg for initiation or titration of ther-\na p yi sa s s o c i a t e dw i t hb e t t e rp r e g -nancy outcomes than reservingtreatment for severe hypertension,with no increase in risk of small-for-gestational-age birth weight. AThere\nare limited data on the optimal lower\nlimit, but therapy should be deintensi fied\nf... | [
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-0.01283... |
for blood pressure <90/60 mmHg. EA\nblood pressure target of 110– 135/\n85 mmHg is suggested in the interestof reducing the risk for accelerated ma-ternal hypertension. A\n15.22 Potentially harmful medica-\ntions in pregnancy (i.e., ACE inhibi- | [
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-0.065... |
tions in pregnancy (i.e., ACE inhibi-\ntors, angiotensin receptor blockers,statins) should be stopped prior toconception and avoided in sexuallyactive individuals of childbearingpotential who are not using reliable\ncontraception. B\nIn normal pregnancy, blood pressure is | [
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0.067674919962883,
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0.0039725480... |
contraception. B\nIn normal pregnancy, blood pressure is\nlower than in the nonpregnant state.The Chronic Hypertension and Preg-nancy (CHAP) Trial Consortium ’sR C To n\ntreatment for mild chronic hypertensionduring pregnancy demonstrated that\na blood pressure of 140/90 mmHg, as | [
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a blood pressure of 140/90 mmHg, as\nthe threshold for initiation or titrationof treatment, reduces the incidence ofadverse pregnancy outcomes withoutcompromising fetal growth (123). TheCHAP Consortium ’s study mitigates con-\ncerns about small-for-gestational-age birth\nweight. Attained mean ± SD blood pres- | [
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weight. Attained mean ± SD blood pres-\nsure measurements in the treated versusuntreated groups were systolic 129.5 ±10.0 vs. 132.6 ± 10.1 mmHg (between-group difference /C03.11 [95% CI /C03.95 to\n2.28]) and diastolic 79.1 ± 7.4 vs. 81.5 ±8.0 mmHg ( /C02.33 [95% CI /C02.97 to | [
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0.04]) (123). Individuals with diabetes hadan even better composite outcome scorethan those without diabetes (123).\nAs a result of the CHAP study, ACOG\nissued a Practice Advisory recommend-ing a blood pressure of 140/90 mmHgas the threshold for initiation or titra- | [
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0.03272218629717827,
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0.0012389984913170338,
-0.00432... |
tion of medical therapy for chronic hy-pertension in pregnancy (124) ratherthan their previously recommendedthreshold of 160/110 mmHg (125).\nThe CHAP study provides additional\nguidance for the management of hyper-tension in pregnancy. Data from the pre-viously published Control of Hypertensionin Pregnancy Study (CHIP... | [
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... |
target blood pressure goal of 110 –135/85\nmmHg to reduce the risk of uncontrolled\nmaternal hypertension and minimize im-paired fetal growth (125 –127). The 2015 | [
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study (126) excluded pregnancies compli-cated by preexisting diabetes, and only6% of participants had GDM at enroll-ment. There was no difference in preg-nancy loss, neonatal care, or other\nneonatal outcomes between the groups\nwith tighter versus less tight control ofhypertension (126).\nDuring pregnancy, treatment w... | [
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During pregnancy, treatment with ACE\ninhibitors and angiotensin receptor block-\ners is contraindicated because they may\ncause fetal renal dysplasia, oligohydram-nios, pulmonary hypoplasia, and intra-uterine growth restriction (23).\nA large study found that after adjust-\ning for confounders, first trimester ACE | [
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-... |
ing for confounders, first trimester ACE\ninhibitor exposure does not appear to beassociated with congenital malforma-tions (128). However, ACE inhibitors and\nangiotensin receptor blockers should be\ns t o p p e da ss o o na sp o s s i b l ei nt h e first | [
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