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to randomization were characterized by\nhigh-fat, low- fiber, and poor-quality car-\nbohydrate intakes. Fruit and vegetableconsumption was inadequate, with onein four participants at risk for micronutri-ent de ficiencies, highlighting the impor-\ntance of medical nutrition therapy (27).An expert panel on nutrition in pre... | [
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nancy recommends a balance of macro-\nnutrients. A diet that severely restrictsany macronutrient class should be avoided,specifically the ketogenic diet that lacks\ncarbohydrates, the Paleo diet because ofdairy restriction, and any diet characterizedby excess saturated fats. Nutrient-dense,whole foods are recommended, i... | [
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ing fruits, vegetables, legumes, whole\ngrains, and healthy fats with n-3 fattyacids that include nuts and seeds andfish, which are less likely to promote ex-\ncessive weight gain. Processed foods,fatty red meat, and sweetened foodsand beverages should be limited (28).\nInsulin Physiology | [
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Insulin Physiology\nGiven that early pregnancy may be atime of enhanced insulin sensitivity and\nlower glucose levels, many people with\ntype 1 diabetes will have lower insulin re-quirements and an increased risk forhypoglycemia (29). At around 16 weeks,\ninsulin resistance begins to increase, and | [
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insulin resistance begins to increase, and\ntotal daily insulin doses increase linearly/C245% per week through week 36. This | [
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usually results in a doubling of daily insu-lin dose compared with the prepregnancyrequirement. While there is an increase inboth basal and bolus insulin requirements,bolus insulin requirements take up a largerproportion of overall total daily insulinneeds in individuals with preexisting diabe-t e sa sp r e g n a n c y... | [
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diabe-t e sa sp r e g n a n c yp r o g r e s s e s( 3 0 , 3 1 ) .T h einsulin requirement levels off toward the | [
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e n do ft h et h i r dt r i m e s t e r .Ar a p i dr e d u c -\ntion in insulin requirements can indicatethe development of placental insuffi ciency\n( 3 2 ) .I np e o p l ew i t hn o r m a lp a n c r e a t i cfunction, insulin production is suf ficient to | [
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meet the challenge of this physiological in-sulin resistance and to maintain normalglucose levels. However, in people with di-abetes, hyperglycemia occurs if treatmentis not adjusted appropriately.\nGlucose Monitoring\nReflecting this physiology, fasting and | [
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Glucose Monitoring\nReflecting this physiology, fasting and\npostprandial blood glucose monitoringis recommended to achieve metaboliccontrol in pregnant people with diabe-tes. Preprandial testing is also recom-\nmended when using insulin pumps or | [
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mended when using insulin pumps or\nbasal-bolus therapy so that premealrapid-acting insulin dosage can be ad-justed. Postprandial monitoring is asso-ciated with better glycemic outcomesand a lower risk of preeclampsia (32 –34). | [
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There are no adequately powered ran-domized trials comparing different fastingand postmeal glycemic goals for pre-existing diabetes in pregnancy.\nSimilar to the targets recommended\nby ACOG (upper limits are the same asfor GDM, described below) (35), theADA-recommended targets for pregnant\npeople with type 1 or type ... | [
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people with type 1 or type 2 diabetes\nare as follows:\n\x81Fasting glucose 70 –95 mg/dL (3.9– 5.3\nmmol/L) and either\n\x81One-hour postprandial glucose 110 –140\nmg/dL (6.1 –7.8 mmol/L) or\n\x81Two-hour postprandial glucose 100 –120\nmg/dL (5.6 –6.7 mmol/L)\nLower limits are based on the mean\nof normal blood glucose... | [
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of normal blood glucose in pregnancy\n(36). Lower limits do not apply to indi-viduals with type 2 diabetes treatedwith nutrition alone. Hypoglycemia inpregnancy is as de fin e da n dt r e a t e di nR e c -\nommendations 6.11 –6.17 (see Section 6,\n“Glycemic Goals and Hypoglycemia ”). The | [
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“Glycemic Goals and Hypoglycemia ”). The\nmost appropriate hypoglycemia thresholdlevel in pregnancy has not been validatedbut has ranged from <60 to<70 mg/dL\n(<3.3 to <3.9 mmol/L) in the past.\nCurrent recommendations for hypogly-cemia thresholds include blood glucose<70 mg/dL ( <3.9 mmol/L) and sensor\nglucose <63 mg... | [
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glucose <63 mg/dL ( <3.5 mmol/L)\n(36,37). These fasting/premeal and post-\nprandial glucose values represent opti-\nmal levels if they can be achieved safely.In practice, it may be challenging for aperson with type 1 diabetes to achievethese goals without hypoglycemia, par-\nticularly those with a history of recurrent | [
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ticularly those with a history of recurrent\nhypoglycemia or hypoglycemia unaware-ness. If an individual cannot achievethese goals without signi ficant hypogly-\ncemia, the ADA suggests less stringentgoals based on clinical experience and\nindividualization of care.\nA1C in Pregnancy\nIn studies of individuals without p... | [
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A1C in Pregnancy\nIn studies of individuals without preex-\nisting diabetes, increasing A1C levelswithin the normal range are associatedwith adverse outcomes (38). In theHyperglycemia and Adverse PregnancyOutcome (HAPO) study, increasing levels\nof glycemia were also associated with | [
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of glycemia were also associated with\nworsening outcomes (39). Observationalstudies in preexisting diabetes and preg-nancy show the lowest rates of adversefetal outcomes in association with A1C\n<6–6.5% (<42–48 mmol/mol) early in\ngestation (4 –6,40). Clinical trials have\nnot evaluated the risks and bene fits of\nachi... | [
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achieving these goals, and treatment\ngoals should account for the risk of ma-ternal hypoglycemia in setting an individ-\nualized goal of <6% (<42 mmol/mol) to\n<7% (<53 mmol/mol). Due to physiolog-\nical increases in red blood cell turnover,\nA1C levels fall during normal pregnancy(41,42). Additionally, as A1C represe... | [
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an integrated measure of glucose, it may\nnot fully capture postprandial hyperglyce-mia, which drives macrosomia. Thus, al-though A1C may be useful, it should beused as a secondary measure of glycemicoutcomes in pregnancy, after blood glu-\ncose monitoring.\nIn the second and third trimesters, A1C\n<6% (<42 mmol/mol) h... | [
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<6% (<42 mmol/mol) has the lowest\nrisk of large-for-gestational-age infants\n(40,43,44), preterm delivery (45), anddiabetesjournals.org/care Management of Diabetes in Pregnancy S285\n©AmericanDiabetesAssociation | [
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preeclampsia (1,46). Taking all of this into\naccount, a goal of <6% (<42 mmol/mol)\nis optimal during pregnancy if it can be\nachieved without signi ficant hypoglyce-\nmia. The A1C goal in a given individualshould be achieved without hypoglyce-\nmia, which, in addition to the usual ad-verse sequelae, may increase the r... | [
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low birth weight (47,48). Given the alter-\na t i o ni nr e db l o o dc e l lk i n e t i c sd u r i n gpregnancy and physiological changes in\nglycemic parameters, A1C levels may\nneed to be monitored more frequently\nthan usual (e.g., monthly).\nContinuous Glucose Monitoring in\nPregnancy\nCONCEPTT was a randomized co... | [
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Pregnancy\nCONCEPTT was a randomized controlled\ntrial (RCT) of real-time continuous glu-cose monitoring (CGM) in addition to\nstandard care, including optimization of\npre- and postprandial glucose goals ver-\nsus standard care for pregnant people\nwith type 1 diabetes. It demonstratedthe value of real-time CGM in pre... | [
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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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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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0.14579224586486816,
-0.026765581220388412,
0.041891954839229584,
-0.0007970727165229619,
0.03953580558300018,
-0.091660290956497... |
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 | [
0.02961575612425804,
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0.017173007130622864,
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0.0894346758723259,
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0.03877267614006996,
0.06354518234729767,
-0.048525769263505936,
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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0.008744195103645325,
-0.020368007943034172,
-0... |
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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0.04006427526473999,
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0.... |
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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0.0570469... |
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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0.06725624948740005,
-0.06425842642784119,
0.0098307... |
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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-0.0083... |
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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0.01... |
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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0.0013056992320343852,
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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,
0.04614284634590149,
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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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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,
-0.03046506829559803,
0.0251163300126791,
-0.1409885585308075,
0.0143780... |
used in pregnancy complicated bytype 1 diabetes. C\nThe physiology of pregnancy necessitates | [
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0.06003433093428612,
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-0.03149... |
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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0.050843771547079086,
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0.0... |
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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0.034544408321380615,
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0.03298... |
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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0.06038488447666168,
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-0... |
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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0.019388297572731972,
-0.0888928547501564,
0.0227... |
wear in pregnancy should include rele- | [
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0.022963544353842735,
0.021177422255277634,
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-0.063665... |
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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0.004327194765210152,
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0.04836997389793396,
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0.... |
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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0.00656... |
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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0.03689845651388168,
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-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 | [
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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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0.08148753643035889,
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0.016335468739271164,
-0.11224227398633957,
-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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0.019211... |
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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