Females with type 1 diabetes (T1DM) have unique needs during the

Females with type 1 diabetes (T1DM) have unique needs during the preconception pregnancy and postpartum periods. tight glycemic control of T1DM during pregnancy. Data regarding continuous glucose monitoring (CGM) in pregnant women with T1DM is usually conflicting regarding improved glycemic control. However a recent CGM study does provide some unique patterns of glucose levels associated with large for gestational age infants. Frequent vision exams during pregnancy are essential due to risk of progression of retinopathy during pregnancy. Chronic hypertension treatment goals are systolic blood pressure 110-129?mmHg and diastolic blood pressure 65-79?mmHg. Labor and delivery target plasma glucose levels are 80-110?mg/dl and an insulin drip is recommended to achieve these targets during active labor. Postpartum insulin doses must be reduced and glucoses closely monitored in women with T1DM because of the enhanced insulin sensitivity after delivery. Breastfeeding is recommended and should be highly encouraged due to maternal benefits including increased insulin sensitivity and weight loss and infant and child years benefits including reduced prevalence of overweight. In this article we discuss the care of pregnant patients with T1DM. Keywords: Type 1 ON-01910 diabetes Pregnancy Preconception Postpartum Introduction Type 1 diabetes (T1DM) affects about 0.1-0.2?% of all pregnancies. Education effective contraception preconception planning tight glycemic control and comprehensive medical care can decrease maternal fetal and pregnancy risks associated with T1DM. Therefore all women of childbearing age should be counseled about the increased pregnancy risks associated with T1DM to ensure that pregnancies are planned. This review article will discuss the current standards of care and latest research for Rabbit Polyclonal to GIT1. T1DM and pregnancy in the preconception pregnancy and postpartum periods. Preconception Counseling The goals of preconception care should be tight glycemic control with an A1C <7?% and as close ON-01910 to 6?% as you possibly can without significant hypoglycemia. Since the hemoglobin A1C (A1C) at conception significantly affects pregnancy outcomes pregnancy planning and preconception counseling regarding limited glycemic control are extremely important for ladies with T1DM [1]. Elevated blood glucose levels at conception and during the early 1st trimester are associated with improved rates of congenital malformations most commonly cardiac and neural tube defects. Compared with the general populace rate of 2?% the prevalence of congenital malformations raises with increasing first trimester A1C (Fig.?1) [2]. Higher A1Cs early in pregnancy are also associated with higher prevalence of ON-01910 spontaneous abortions [3 4 intrauterine fetal demise [5] preeclampsia [6?] preterm deliveries [7 8 and perinatal mortality [1]. Fig. 1 Preconception A1C vs complete risk of congenital anomaly (with permission from American Diabetes Association: Guerin A Nisenbaum R Ray JG. Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of ladies with … To improve pregnancy ON-01910 outcomes preconception care should be comprehensive and include contraception planning counseling about risks and optimization of glycemic control body mass index (BMI) and nourishment. Individuals with T1DM who have planned pregnancies enjoy better results including reduced prevalence of congenital malformations [9] higher gestational age at delivery [10] lower A1C before and during pregnancy [9] lower cesarean delivery rates [11] and decreased perinatal mortality [9]. Tight glycemic control is the cornerstone of preconception care to improve results in this patient population and preventing contraception only after the goal A1C has been achieved is recommended for best results [12]. Approximately 40-60?% of individuals with pre-existing diabetes statement that their pregnancies were not planned [13 14 Factors associated with planned pregnancies include higher income higher education levels private health insurance endocrinology care prior to pregnancy married Caucasian and encouragement using their physician [14]. Further physicians often neglect preconception counseling [15]. We recommend ongoing education about contraception and preconception planning starting in the teen years. Contraceptive methods must match the woman’s way of life and be used reliably..