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to discourage youth from ever smoking.\nSee Section 5, “Facilitating Positive Health\nBehaviors and Well-being to Improve\nHealth Outcomes, ”for more information\nabout smoking, tobacco, and electronic\ncigarettes in people with diabetes.\nAs alcohol use has implications for\nglycemic management and safety in\nyouth an... | [
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youth and young adults with diabetes,\nefforts are warranted to reduce alcohol\nuse and increase education about the\nrisks of alcohol use and strategies to\nminimize risks. A psychoeducational in-tervention for adolescents with chronic\nmedical conditions, including type 1 dia-\nbetes, has demonstrated bene fits for | [
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betes, has demonstrated bene fits for\nknowledge, perceived bene fits, and re-\nduced use (280).\nTRANSITION FROM PEDIATRIC TO\nADULT CARE\nRecommendations\n14.108 Pediatric diabetes care teams\nshould implement transition prepara-\ntion programs for youth beginning in\nearly adolescence and, at the latest, | [
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early adolescence and, at the latest,\nat least 1 year before the anticipatedtransfer from pediatric to adult healthcare. E\n14.109 Interprofessional adult and pe-\ndiatric health care teams should providesupport and resources for adolescents,\nyoung adults, and their families prior to | [
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young adults, and their families prior to\nand during the transition process frompediatric to adult health care. E\n14.110 Pediatric diabetes specialists\nshould partner with youth with diabe-tes and their caregivers to decide onthe timing of transfer to an adult dia-\nbetes specialist. E\nCare and close supervision of... | [
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betes specialist. E\nCare and close supervision of diabetes\nmanagement are increasingly shifted from\nparents and other adults to the youth with\ntype 1 or type 2 diabetes throughout child-\nhood and adolescence. The shift from pe-\ndiatric to adult health care professionals,\nhowever, often occurs abruptly as theolde... | [
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stage, referred to as emerging adulthooddiabetesjournals.org/care Children and Adolescents S273\n©AmericanDiabetesAssociation | [
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(281), which is a critical period for young\npeople who have diabetes. During this pe-riod of major life transitions, youth maybegin to move out of their parents ’or\ncaregivers ’homes and become increas-\ningly responsible for their diabetes care. | [
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ingly responsible for their diabetes care.\nTheir new responsibilities include self-management of their diabetes, makingmedical appointments, and financing\nhealth care once they are no longer cov-\nered by their parents ’health insurance\nplans (ongoing coverage until age 26 years | [
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plans (ongoing coverage until age 26 years\nis currently available under provisions ofthe U.S. Affordable Care Act). In additionto lapses in health care, this is also a period\nassociated with deterioration in glycemic | [
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associated with deterioration in glycemic\nstability; increased occurrence of acutecomplications; psychosocial, emotional,and behavioral challenges; and the emer-gence of chronic complications (282 –287). | [
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The transfer period from pediatric to adultcare is prone to fragmentation in healthcare delivery, which may adversely impacthealth care quality, cost, and outcomes(288). Worsening diabetes health out-\ncomes during the transition to adult care\nand early adulthood have been docu-mented (289,290).\nIt is clear that comp... | [
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It is clear that comprehensive and co-\nordinated planning that begins in earlyadolescence is necessary to facilitate a\nseamless transition from pediatric to\nadult health care (282,283,291,292). Re-search on effective interventions to pro-mote successful transition to adult careis limited, although there are promisin... | [
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developments that may improve atten-\ndance at follow-up appointments andlower hospitalizations (293). Use of transi-tion coordinators, technology to supportcommunication with young adults, and\nother interventions may be useful in ad-\ndressing the identi fied needs and preferen-\nces of young adults for transition (29... | [
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ces of young adults for transition (294) and\nin supporting successful establishment inadult care settings (295 –300). Given the be-\nhavioral, psychosocial, and developmentalfactors that relate to this transition, diabe-tes care teams addressing transition shouldinclude physicians, certi fied diabetes care\nand educati... | [
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and education specialists, nurses, behav-\nioral health professionals, nutritionists, and\nsocial workers (61,301). Resources to en-hance social/peer support during the transi-tion process may also be valuable (302).A comprehensive discussion regarding the\nchallenges faced during this period, includ-\ning speci fic rec... | [
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ing speci fic recommendations, is found in\nthe ADA position statement “Diabetes Carefor Emerging Adults: Recommendations for\nTransition From Pediatric to Adult DiabetesCare Systems ”(283).\nThe Endocrine Society, in collabora-\ntion with the ADA and other organiza-tions, has developed transition tools forclinicians an... | [
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0.05567145347595215,
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0.0315... |
Pediatr Diabetes 2012;13:540 –544\n20. Lundgren M, Sahlin Å, Svensson C, et al.;DiPiS study group. Reduced morbidity at diagnosisa n di m p r o v e dg l y c e m i cc o n t r o li nc h i l d r e np r e -viously enrolled in DiPiS follow-up. Pediatr Dia-\nbetes 2014;15:494 –501\n2 1 .B e l lK J ,G r a yR ,M u n n sD ,e ta... | [
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-0... |
2 1 .B e l lK J ,G r a yR ,M u n n sD ,e ta l .C l i n i c a l\napplication of the food insulin index for mealtimeinsulin dosing in adults with type 1 diabetes: arandomized controlled trial. Diabetes TechnolTher 2016;18:218– 225 | [
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-0.013772469013929367,
0.0323302261531353,
-0.04028920456767082,
-0.0368... |
22. Bell KJ, Gray R, Munns D, et al. Estimatinginsulin demand for protein-containing foodsusing the food insulin index. Eur J Clin Nutr2014;68:1055– 1059\n23. Lopez PE, Evans M, King BR, et al. Arandomized comparison of three prandial insulin\ndosing algorithms for children and adolescents with\ntype 1 diabetes. Diabet... | [
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-0.042745787650346756,
0.02... |
type 1 diabetes. Diabet Med 2018;35:1440– 1447\n24. Paterson MA, Smart CE, Lopez PE, et al.Influence of dietary protein on postprandial\nblood glucose levels in individuals with type 1diabetes mellitus using intensive insulin therapy.\nDiabet Med 2016;33:592– 598\n25. Furthner D, Lukas A, Schneider AM, et al. | [
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25. Furthner D, Lukas A, Schneider AM, et al.\nThe role of protein and fat intake on insulintherapy in glycaemic control of paediatric type 1diabetes: a systematic review and research gaps.Nutrients 2021;13:3558\n26. Smith TA, Smart CE, Fuery MEJ, et al. In\nchildren and young people with type 1 diabetes | [
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children and young people with type 1 diabetes\nusing pump therapy, an additional 40% of theinsulin dose for a high-fat, high-protein breakfastimproves postprandial glycaemic excursions: across-over trial. Diabet Med 2021;38:e14511\n27. Smith TA, Smart CE, Howley PP , Lopez PE,\nKing BR. For a high fat, high protein br... | [
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King BR. For a high fat, high protein breakfast,\npreprandial administration of 125% of the insulindose improves postprandial glycaemic excursionsS274 Children and Adolescents Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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15. Management of Diabetes in\nPregnancy: Standards of Care in\nDiabetes— 2024\nDiabetes Care 2024;47(Suppl. 1):S282 –S294 |https://doi.org/10.2337/dc24-S015American Diabetes Association\nProfessional Practice Committee *\nThe American Diabetes Association (ADA) “Standards of Care in Diabetes ”includes | [
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the ADA ’s current clinical practice recommendations and is intended to provide the\ncomponents of diabetes care, general treatment goals and guidelines, and tools to | [
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evaluate quality of care. Members of the ADA Professional Practice Committee, aninterprofessional expert committee, are responsible for updating the Standards ofCare annually, or more frequently as warranted. For a detailed description of ADA\nstandards, statements, and reports, as well as the evidence-grading system f... | [
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clinical practice recommendations and a full list of Professional Practice Committee\nmembers, please refer to Introduction and Methodology. Readers who wish to com-ment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.\nDIABETES IN PREGNANCY | [
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DIABETES IN PREGNANCY\nThe prevalence of diabetes in pregnancy has been increasing in the U.S. in parallel\nwith the worldwide epidemic of obesity. Not only is the prevalence of type 1 diabetes\nand type 2 diabetes increasing in individuals of reproductive age, but there is also a | [
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dramatic increase in the reported rates of gestational diabetes mellitus (GDM). Diabe-tes confers signi ficantly greater maternal and fetal risk largely related to the degree of\nhyperglycemia but also related to chronic complications and comorbidities of diabe-\ntes. In general, specifi c risks of diabetes in pregnancy ... | [
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fetal anomalies, preeclampsia, fetal demise, macrosomia, neonatal hypoglycemia, neo-\nnatal hyperbilirubinemia, and neonatal respiratory distress syndrome, among others.\nIn addition, diabetes in pregnancy increases the risks of obesity, hypertension, and\ntype 2 diabetes in offspring later in life (1,2).\nPreconceptio... | [
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Preconception Counseling\nRecommendations\n15.1 Starting at puberty and continuing in all people with diabetes and child-\nbearing potential, preconception counseling should be incorporated into rou-\ntine diabetes care. A\n15.2 Family planning should be discussed, and effective contraception (with con- | [
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sideration of long-acting, reversible contraception) should be prescribed and useduntil an individual ’s treatment plan and A1C are optimized for pregnancy. A\n15.3 Preconception counseling should address the importance of achieving\nglucose levels as close to normal as is safely possible, ideally A1C <6.5% | [
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(<48 mmol/mol), to reduce the risk of congenital anomalies, preeclampsia,\nmacrosomia, preterm birth, and other complications. A*A complete list of members of the American\nDiabetes Association Professional Practice Committeecan be found at https://doi.org/10.2337/dc24-SINT.\nDuality of interest information for each au... | [
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Duality of interest information for each author is\navailable at https://doi.org/10.2337/dc24-SDIS.\nSuggested citation: American Diabetes Association\nProfessional Practice Committee. 15. Manage-ment of diabetes in pregnancy: Standards of Care in\nDiabetes —2024. Diabetes Care 2024;47(Suppl. 1):\nS282–S294 | [
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Diabetes —2024. Diabetes Care 2024;47(Suppl. 1):\nS282–S294\n© 2023 by the American Diabetes Association.Readers may use this article as long as thework is properly cited, the use is educationaland not for pro fit, and the work is not altered. | [
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More information is available at https://www.diabetesjournals.org/journals/pages/license.15. MANAGEMENT OF DIABETES IN PREGNANCYS282 Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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All individuals with diabetes and childbear-\ning potential should be informed about\nthe importance of achieving and maintain-ing as near euglycemia as safely possible\nprior to conception and throughout preg-\nnancy. Observational studies show an\nincreased risk of diabetic embryopathy,\nespecially anencephaly, micro... | [
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especially anencephaly, microcephaly,\ncongenital heart disease, renal anoma-\nlies, and caudal regression, directly pro-portional to elevations in A1C during the\nfirst 10 weeks of pregnancy (3). Although\nobservational studies are confounded bythe association between elevated peri-\nconceptional A1C and other engageme... | [
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conceptional A1C and other engagement\nin self-care behaviors, the quantity and\nconsistency of data are convincing andsupport the recommendation to opti-\nmize glycemia prior to conception with\nan A1C <6.5% (<48 mmol/mol), as this\nis associated with the lowest risk of con-genital anomalies (given that organogen- | [
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esis occurs primarily at 5 –8 weeks of\ngestation), preeclampsia, and pretermbirth (3 –7). In a systematic review and\nmeta-analysis of observational studies,\npreconception care for pregnant individ-\nuals with preexisting diabetes was asso-\nciated with lower A1C and reduced risks\nof birth defects, preterm delivery,... | [
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of birth defects, preterm delivery, peri-\nnatal mortality, small-for-gestational-age\nbirths, and neonatal intensive care unit\nadmissions (8).\nThere are opportunities at any health\ncare visit to educate all adults and ado-\nlescents with diabetes and childbearing\npotential about the risks of unplanned\npregnancies... | [
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pregnancies and about improved mater-\nnal and fetal outcomes with pregnancy\nplanning (9). Education and counseling\nshould be offered, even when individu-als already use contraception or do not\nintend to conceive. Effective preconcep-\ntion counseling could avert substantial\nhealth and associated cost (10) burdens | [
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health and associated cost (10) burdens\nin the offspring (11). Family planning\nshould be discussed, including the bene-\nfits of long-acting, reversible contracep-\ntion, and effective contraception should\nbe prescribed and used until the individ-\nual is prepared and ready to become\npregnant (12 –16).\nTo minimize ... | [
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pregnant (12 –16).\nTo minimize the occurrence of com-\nplications, beginning at the onset of\npuberty or at diagnosis, all adults and\nadolescents with diabetes of childbear-ing potential should receive education\nabout 1) the risks of malformations\nassociated with unplanned pregnanciesand even with mild hyperglycemi... | [
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2) the use of effective contraception at\nall times when trying to prevent a preg-\nnancy. Preconception counseling using\ndevelopmentally appropriate educational\ntools enables adolescent girls to makewell-informed decisions (9). Preconcep-tion counseling resources tailored for\nadolescents are available at no cost | [
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adolescents are available at no cost\nthrough the American Diabetes Associ-ation (ADA) (17).\nPreconception Care\nRecommendations\n15.4 Individuals with preexisting diabe-\ntes who are planning a pregnancy\nshould ideally begin receiving interpro-\nfessional care for preconception, which | [
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fessional care for preconception, which\nincludes an endocrinology health careprofessional, maternal-fetal medicine\nspecialist, registered dietitian nutrition-\nist, and diabetes care and education\nspecialist, when available. B\n15.5 In addition to focused attention\non achieving glycemic targets, Astan-\ndard precon... | [
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dard preconception care should be\na u g m e n t e dw i t he x t r af o c u so nn u t r i -\ntion, physical activity, diabetes self-\ncare education, and screening for\ndiabetes comorbidities and compli-\ncations. B\n15.6 Individuals with preexisting type 1\nor type 2 diabetes who are planning a\npregnancy or who have ... | [
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pregnancy or who have become preg-\nnant should be counseled on the risk\nof development and/or progression\nof diabetic retinopathy. Dilated eye\nexaminations should occur ideally\nbefore pregnancy or in the first tri-\nmester, and then pregnant indivi-duals should be monitored every\ntrimester and for 1 year postpartu... | [
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trimester and for 1 year postpartum\nas indicated by the degree of reti-\nnopathy and as recommended by\nthe eye care health care profes-\nsional. B\nThe importance of preconception care\nfor all pregnant people is highlighted by\nAmerican College of Obstetricians andGynecologists (ACOG) Committee Opinion762, “Prepregn... | [
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conception counseling for pregnant peo-ple with preexisting type 1 or type 2diabetes is highly effective in reducingthe risk of congenital malformations\nand decreasing the risk of preterm deliv-\nery and admission to neonatal intensivecare units. Preconception counseling is | [
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also associated with reductions in perina-tal mortality and small-for-gestational-agebirth weight (18). A key point is theneed to incorporate a question about\nplans for pregnancy into the routine pri-\nmary and gynecologic care of peoplewith diabetes. Preconception care forpeople with diabetes should include the\nstan... | [
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standard screening and care recom-\nmended for any person planning preg-nancy (10). Prescription of prenatalvitamins with at least 400 mgo ff o l i c\nacid (10) and 150 mg of potassium io-dide (19) is recommended prior to con-ception. Review and counseling on theabstinence of use of nicotine products,alcohol, and recre... | [
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ing marijuana, is important. Standard\ncare includes screening for sexuallytransmitted diseases and thyroid dis-ease, recommended vaccinations, rou-\ntine genetic screening, a careful review\nof all prescription and nonprescriptionmedications, herbal supplements, andnonherbal supplements used, and a re-\nview of travel... | [
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view of travel history and plans with\nspecial attention to areas known tohave Zika virus, as outlined by ACOG.SeeTable 15.1 for additional details on\nelements of preconception care (10,20).\nCounseling on the speci fic risks of | [
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Counseling on the speci fic risks of\nobesity in pregnancy and lifestyle inter-ventions to prevent and treat obesity,including referral to a registered dieti-tian nutritionist (RDN), is recommended\n(21).\nDiabetes-speci ficc o u n s e l i n gs h o u l d\ninclude an explanation of the risks to | [
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include an explanation of the risks to\nmother and fetus related to pregnanciesassociated with diabetes and the ways\nto reduce risks, including glycemic goal\nsetting, lifestyle and behavioral man-agement, and medical nutrition therapy(18). The most important diabetes-\nspeci fic component of preconception\ncare is the... | [
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care is the attainment of glycemic\ngoals prior to conception. In addition,the presence of microvascular compli-\ncations is associated with higher risk of\ndisease progression and adverse preg-nancy outcomes (22). Diabetes-speci fic\ntesting should include A1C, creatinine, andurinary albumin-to-creatinine ratio. Specia... | [
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attention should be paid to the review of\nthe medication list for potentially harmfuldrugs, i.e., ACE inhibitors (23,24), angio-tensin receptor blockers (23), and statins\n(24,25). A referral for a comprehensive\neye exam is recommended. Individualsdiabetesjournals.org/care Management of Diabetes in Pregnancy S283\n©A... | [
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with preexisting diabetic retinopathy\nwill need close monitoring during preg-nancy to assess stability or progression\nof retinopathy and provide treatment if\nindicated (26).\nGLYCEMIC GOALS IN PREGNANCY\nRecommendations\n15.7 Fasting, preprandial, and postpran-\ndial blood glucose monitoring are rec-\nommended in in... | [
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ommended in individuals with diabetes\nin pregnancy to achieve optimal glucoselevels. Glucose goals are fasting plasma\nglucose <95 mg/dL ( <5.3 mmol/L)\nand either 1-h postprandial glucose<140 mg/dL ( <7.8 mmol/L) or 2-h\npostprandial glucose <120 mg/dL\n(<6.7 mmol/L). B\n15.8 Due to increased red blood cell\nturnover... | [
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turnover, A1C is slightly lower during\npregnancy in people with and with-\nout diabetes. Ideally, the A1C goal in\npregnancy is <6% (<42 mmol/mol)\nif this can be achieved without signifi -\ncant hypoglycemia, but the goal maybe relaxed to <7% (<53 mmol/mol) if\nnecessary to prevent hypoglycemia. B\n15.9 When used in a... | [
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0.015... |
15.9 When used in addition to pre-\nand postprandial blood glucose moni-toring, continuous glucose monitoring\n(CGM) can help to achieve the A1C\ngoal in diabetes and pregnancy. B\n15.10 CGM is recommended in preg-\nnancies associated with type 1 diabe-\ntes.AWhen used in addition to blood\nglucose monitoring, achievin... | [
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glucose monitoring, achieving tradi-\ntional pre- and postprandial goals,\nreal-time CGM can reduce the risk for\nlarge-for-gestational age infants and\nneonatal hypoglycemia in pregnancy\ncomplicated by type 1 diabetes. A\n15.11 CGM metrics may be used in\naddition to but should not be used as\na substitute for blood ... | [
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a substitute for blood glucose moni-\ntoring to achieve optimal pre- and\npostprandial glycemic goals. E\n15.12 Commonly used estimated A1C\nand glucose management indicator cal-\nculations should not be used in preg-\nnancy as estimates of A1C. C\n15.13 Nutrition counseling should\nendorse a balance of macronutrients | [
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15.13 Nutrition counseling should\nendorse a balance of macronutrients\nincluding nutrient-dense fruits, vege-\ntables, legumes, whole grains, and\nhealthy fats with n-3 fatty acids that\ni n c l u d en u t sa n ds e e d sa n d fish in\nthe eating pattern. ETable 15.1 —Checklist for preconception care for people with di... | [
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Preconception education should include:\nwComprehensive nutrition assessment and recommendations for:\n/C15Overweight/obesity or underweight\n/C15Meal planning\n/C15Correction of dietary nutritional de ficiencies\n/C15Caffeine intake\n/C15Safe food preparation technique\nwLifestyle recommendations for:\n/C15Regular mode... | [
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wLifestyle recommendations for:\n/C15Regular moderate exercise\n/C15Avoidance of hyperthermia (hot tubs)\n/C15Adequate sleep\nwComprehensive diabetes self-management education\nwCounseling on diabetes in pregnancy per current standards, including: natural history of | [
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insulin resistance in pregnancy and postpartum; preconception glycemic goals; avoidance of\nDKA/severe hyperglycemia; avoidance of severe hypoglycemia; progression of retinopathy;\nPCOS (if applicable); fertility in people with diabetes; genetics of diabetes; risks to | [
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pregnancy including miscarriage, still birth, congenital malformations, macrosomia, pretermlabor and delivery, hypertensive disorders in pregnancy, etc.\nwSupplementation\n/C15Folic acid supplement (400 mg routine)\n/C15Appropriate use of over-the-counter medications and supplements\nHealth assessment and plan should i... | [
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Health assessment and plan should include:\nwGeneral evaluation of overall health\nwEvaluation of diabetes and its comorbidities and complications, including DKA/severe\nhyperglycemia; severe hypoglycemia/hypoglycemia unawareness; barriers to care;\ncomorbidities such as hyperlipidemia, hypertension, NAFLD, PCOS, and t... | [
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dysfunction; complications such as macrovascular disease, nephropathy, neuropathy\n(including autonomic bowel and bladder dysfunction), and retinopathy\nwEvaluation of obstetric/gynecologic history, including a history of cesarean section, | [
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congenital malformations or fetal loss, current methods of contraception, hypertensivedisorders of pregnancy, postpartum hemorrhage, preterm delivery, previous\nmacrosomia, Rh incompatibility, and thrombotic events (DVT/PE)\nwReview of current medications and appropriateness during pregnancy\nScreening should include: | [
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Screening should include:\nwDiabetes complications and comorbidities, including comprehensive foot exam;\ncomprehensive ophthalmologic exam; ECG in individuals starting at age 35 years who\nhave cardiac signs/symptoms or risk factors and, if abnormal, further evaluation; lipid\npanel; serum creatinine; TSH; and urine a... | [
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panel; serum creatinine; TSH; and urine albumin-to-creatinine ratio\nwAnemia\nwGenetic carrier status (based on history):\n/C15Cystic fibrosis\n/C15Sickle cell anemia\n/C15Tay-Sachs disease\n/C15Thalassemia\n/C15Others if indicated\nwInfectious disease\n/C15Neisseria gonorrhoeae/Chlamydia trachomatis\n/C15Hepatitis B an... | [
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-0.019060153514146805,
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/C15Hepatitis B and hepatitis C\n/C15HIV\n/C15Pap smear\n/C15Syphilis\nImmunizations should include:\nwInactivated infl uenza\nwTdap (tetanus, diphtheria, and pertussis)\nwCOVID-19 (certain populations)\nwHepatitis A and hepatitis B (certain populations)\nwOthers if indicated\nPreconception plan should include: | [
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0.05... |
wOthers if indicated\nPreconception plan should include:\nwNutrition and medication plan to achieve glycemic goals prior to conception, including appropriateimplementation of monitoring, continuous glucose monitoring, and pump technology\nwContraceptive plan to prevent pregnancy until glycemic goals are achieved | [
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wManagement plan for general health, gynecologic concerns, comorbid conditions, or\ncomplications, if present, including hypertension, nephropathy, retinopathy; Rh\nincompatibility; and thyroid dysfunction\nCreated using information from American College of Obstetricians and Gynecologists (10) and Ra- | [
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mos (20). COVID-19, coronavirus disease 2019; DKA, diabetic ketoacidosis; DVT/PE, deep vein\nthrombosis/pulmonary embolism; ECG, electrocardiogram; NAFLD, nonalcoholic fatty liver disease;PCOS, polycystic ovary syndrome; TSH, thyroid-stimulating hormone.S284 Management of Diabetes in Pregnancy Diabetes Care Volume 47, ... | [
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©AmericanDiabetesAssociation | [
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Pregnancy in people with normal glu-\ncose metabolism is characterized byfasting levels of blood glucose that arelower than in the nonpregnant statedue to insulin-independent glucose up-take by the fetus and placenta and by\nmild postprandial hyperglycemia and | [
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mild postprandial hyperglycemia and\ncarbohydrate intolerance as a result ofdiabetogenic placental factors. In peo-ple with preexisting diabetes, glycemicgoals are usually achieved through acombination of insulin administrationand medical nutrition therapy. Becauseglycemic goals in pregnancy are stricter\nthan in nonpr... | [
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than in nonpregnant individuals, it is\nimportant that pregnant people with dia-betes eat consistent amounts of carbo-hydrates to match with insulin dosageand to avoid hyperglycemia or hypogly-cemia. Referral to an RDN is importantto establish a food plan and insulin-to-carbohydrate ratio and determine weight\ngain goa... | [
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gain goals. The quality of the carbohy-\ndrates should be evaluated. A subgroupanalysis of the Continuous Glucose Mon-itoring in Pregnant Women With Type 1Diabetes Trial (CONCEPTT) study demon-strated that the diets of individuals plan-ning pregnancy and currently pregnantassessed during the run-in phase prior\nto rand... | [
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-0.100235... |
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