Recommendations from others
The American College of Obstetrics and Gynecology (ACOG) recommends that women with pregestational diabetes maintain fasting plasma glucose levels between 60–90 mg/dL and 2-hour postprandial levels <120 mg/dL.8 For women with gestational diabetes who are not controlled within these targets on dietary therapy alone, ACOG recommends the additional of insulin therapy.9
The American Diabetes Association recommends that women with pregestational diabetes maintain capillary plasma glucose levels of 80–110 mg/dL before and <155 mg/dL 2 hours after meals before pregnancy and while trying to conceive.10 The ADA does not list target glucose levels for women with pregestational diabetes once they become pregnant. The ADA recommends the use of diet and insulin therapy to maintain preprandial plasma glucose levels of <105 mg/dL and 2-hour postprandial levels below <130 mg/dL in gestational diabetes.11
CLINICAL COMMENTARY
Glucose control makes a difference for pregnancy outcomes in type I diabetes
Linda French, MD
Michigan State University, East Lansing
It is well accepted that glucose control makes a difference for pregnancy outcomes in women with type 1 diabetes. Since similar studies have not been done in women with preexisting type 2 diabetes, we have to assume that the risk is also high for them. Preconception counseling about glucose control is so important for women with diabetes. Fortunately, because they generally have routine visits for their chronic care, we have an opportunity to initiate discussion of glucose control in relationship to pregnancy planning. Routine diabetes care visits also give us the opportunity to discuss other important preconception topics.
Drug brand names
- Allopurinol • Lopurin, Zyloprim
- Amitriptyline • Elavil, Endep
- Benzbromarone • Urinorm
- Botulinim toxin A • Botox
- Clindamycin • Cleocin
- Fluoxetine • Prozac
- Fluticasone • Flovent
- Gabapentin • Neurontin
- Metronidazole (intravaginal) • MetroGel
- Probenecid • Benemid, Probalan
- Sumatriptan • Imitrex
- Tizanidine • Zanaflex
- Triamcinolone • Azmacort
- Valproate • Depacon