Due to the complexity of insulin management in pregnancy, referral to a specialized center offering team-based care (with team members including maternal-fetal medicine specialist, endocrinologist, or other provider experienced in managing pregnancy in women with preexisting diabetes, dietitian, nurse, and social worker, as needed) is recommended if this resource is available.None of the currently available human insulin preparations have been demonstrated to cross the placenta (While many providers prefer insulin pumps in pregnancy, it is not clear that they are superior to multiple daily injections (Women with type 1 diabetes have an increased risk of hypoglycemia in the first trimester and, like all women, have altered counterregulatory response in pregnancy that may decrease hypoglycemia awareness.
Metformin in Women With Type 2 Diabetes in Pregnancy Trial (MiTy). Insulin resistance drops rapidly with delivery of the placenta.Pregnancy is a ketogenic state, and women with type 1 diabetes, and to a lesser extent those with type 2 diabetes, are at risk for diabetic ketoacidosis (DKA) at lower blood glucose levels than in the nonpregnant state.
In one study, insulin requirements in the immediate postpartum period are roughly 34% lower than prepregnancy insulin requirements (In light of the immediate nutritional and immunological benefits of breastfeeding for the baby, all women including those with diabetes should be supported in attempts to breastfeed. Breastfeeding may also confer longer-term metabolic benefits to both mother (A major barrier to effective preconception care is the fact that the majority of pregnancies are unplanned. DKA carries a high risk of stillbirth. ADA STANDARDS, STATEMENTS, REPORTS, and …
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