1.0.0.0 Di­a­betes in Preg­nan­cy

The Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) “Stan­dards of Med­i­cal Care in Di­a­betes” in­cludes ADA’s cur­rent clin­i­cal prac­tice rec­om­men­da­tions and is in­tend­ed to pro­vide the com­po­nents of di­a­betes care, gen­er­al treat­ment goals and guide­lines, and tools to eval­u­ate qual­i­ty of care. Mem­bers of the ADA Pro­fes­sion­al Prac­tice Com­mit­tee, a mul­ti­dis­ci­plinary ex­pert com­mit­tee, are re­spon­si­ble for up­dat­ing the Stan­dards of Care an­nu­al­ly, or more fre­quent­ly as war­rant­ed. For a de­tailed de­scrip­tion of ADA stan­dards, state­ments, and re­ports, as well as the ev­i­dence-‍grad­ing sys­tem for ADA’s clin­i­cal prac­tice rec­om­men­da­tions, please refer to the Stan­dards of Care In­tro­duc­tion. Read­ers who wish to com­ment on the Stan­dards of Care are in­vit­ed to do so at pro­fes­sion­al.di­a­betes.org/‍SOC.

DI­A­BETES IN PREG­NAN­CY

The preva­lence of di­a­betes in preg­nan­cy has been in­creas­ing in the U.S. The ma­jor­i­ty is ges­ta­tion­al di­a­betes mel­li­tus (GDM) with the re­main­der pri­mar­i­ly pre­ex­ist­ing type 1 di­a­betes and type 2 di­a­betes. The rise in GDM and type 2 di­a­betes in par­al­lel with obe­si­ty both in the U.S. and world­wide is of par­tic­u­lar con­cern. Both type 1 di­a­betes and type 2 di­a­betes in preg­nan­cy con­fer significant­ly greater ma­ter­nal and fetal risk than GDM, with some dif­fer­ences ac­cord­ing to type of di­a­betes. In gen­er­al, specific risks of un­con­trolled di­a­betes in preg­nan­cy in­clude spon­ta­neous abor­tion, fetal anoma­lies, preeclamp­sia, fetal demise, macro­so­mia, neona­tal hy­po­glycemia, and neona­tal hy­per­biliru­bine­mia, among oth­ers. In ad­di­tion, di­a­betes in preg­nan­cy may in­crease the risk of obe­si­ty and type 2 di­a­betes in off­spring later in life (1,2).