DOCSLIB.ORG

A Population-Based Study in Alberta, Canada Diabetes Care 2016;39:55–60 | DOI: 10.2337/Dc15-1421

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Population-Based Study in Alberta, Canada Diabetes Care 2016;39:55–60 | DOI: 10.2337/Dc15-1421 Diabetes Care Volume 39, January 2016 55 Lois E. Donovan,1,2 Anamaria Savu,3 Prevalence and Timing of Alun L. Edwards,1 Jeffrey A. Johnson,3 and Screening and Diagnostic Testing Padma Kaul3,4,5 for Gestational Diabetes Mellitus: A Population-Based Study in Alberta, Canada Diabetes Care 2016;39:55–60 | DOI: 10.2337/dc15-1421 OBJECTIVE The extent to which pregnant women are screened for gestational diabetes mel- MANAGEMENT OF GESTATIONAL DIABETES MELLITUS litus (GDM) at the population level is not known. We examined the rate, type, and timing of GDM screening and diagnostic testing in the province of Alberta, Canada. Geographic and temporal differences in screening rates, and maternal risk factors associated with lower likelihood of screening, were also determined. RESEARCH DESIGN AND METHODS Our retrospective linked-database cohort study included 86,842 primiparous women with deliveries between 1 October 2008 and 31 December 2012. Multi- variable logistic regression analysis was used to examine maternal factors asso- ciated with lower likelihood of GDM screening. RESULTS n Overall, 94% ( = 81,304) of women underwent some form of glycemic assessment 1Division of Endocrinology and Metabolism, De- in the 270 days prior to delivery. The majority (91%) received a 50-g glucose screen partment of Medicine, University of Calgary, (GDS). Women not screened were younger and more likely to smoke and had Calgary, Alberta, Canada 2 lower maternal weight and median household income. When a diagnostic 75-g Department of Obstetrics and Gynecology, Uni- versity of Calgary, Calgary, Alberta, Canada oral glucose tolerance test (OGTT) was indicated, it occurred a median of 10 3Canadian VIGOUR Center, University of Alberta, (interquartile range 7, 15) days after the screen. Edmonton, Alberta, Canada 4School of Public Health, University of Alberta, CONCLUSIONS Edmonton, Alberta, Canada 5 GDS occurred widely in a system where it was universally recommended and paid Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada for publicly. When indicated, a 75-g OGTT was completed within 15 days in 75% of fi Corresponding author: Lois E. Donovan, lois. cases. Our nding that this two-step approach was widely implemented in a [email protected]. timely fashion supports continued endorsement of a two-step approach to Received 30 June 2015 and accepted 3 Septem- screening and diagnosis of GDM. Further research is merited to assess whether ber 2015. the one-step GDM diagnostic approach results in different rates and timing of the This article contains Supplementary Data online 75-g OGTT and affects pregnancy outcomes. at http://care.diabetesjournals.org/lookup/ suppl/doi:10.2337/dc15-1421/-/DC1. © 2016 by the American Diabetes Association. The 50-g oral glucose challenge test (GDS) is a common method of screening for Readers may use this article as long as the work is gestational diabetes mellitus (GDM) in North America. This test is recommended for properly cited, the use is educational and not for all women (1) or selectively for the vast majority (at least 90%) of pregnant women profit, and the work is not altered. (2) who have at least one risk factor for GDM (i.e., older age, non-Caucasian, ele- See accompanying articles, pp. 13, 16, vated BMI, history of adverse pregnancy outcomes, and personal or family history of 24, 31, 39, 43, 50, 53, 61, and 65. 56 Prevalence and Timing of Screening for GDM Diabetes Care Volume 39, January 2016 glucose intolerance) (3). Typically this median household income (MHI) as a value of 10.3 mmol/L (185 mg/dL) or screening test is administered between measure of the socioeconomic status of higher occurred, the woman was assumed 24 and 28 weeks’ gestation, but it has the mothers in the cohort (6). to have GDM and no further diagnostic been recommended earlier in gestation testing was required (10). A 2-h 75-g for those with multiple risk factors for Study Design and Population OGTT was recommended for all women GDM (1). If 1 h after the GDS the blood Our retrospective population-based co- whose GDS fell between 7.8 and glucose level is greater than the selected hort study included all primiparous births 10.2 mmol/L (140 and 184 mg/dL). When cutoff (usually 7.2 or 7.8 mmol/L), a sec- in the province of Alberta, Canada, be- women had GDS ,7.8 mmol/L, no further ond step, an oral glucose tolerance test tween 1 October 2008 and 31 December glucose testing was recommended except (OGTT) (with either 75- or 100-g glucose 2012. Alberta is a large, diverse multicul- in circumstances where the GDS was done load) is performed to confirm the diag- tural province in Canada with .3.9 million prior to 24 weeks’ gestation. According to nosis of GDM. Sensitivity and specificity residents (7). A health insurance plan is these criteria, women were diagnosed values of the GDS for predicting the out- paid for by the Alberta Government with impaired glucose tolerance of preg- come on an OGTT range from 70 to 99% that covers all necessary medical service nancy or GDM if they had exactly one, or and 66 to 89%, respectively, depending expenses in the province. Population-level two or more, glucose values, respectively, on the glucose thresholds selected for laboratory data for the entire province ex- on the 75-g OGTT at or above the following the positive screening result and diag- cept for one of the nine health regions glucose thresholds: fasting, 5.3 mmol/L; nostic OGTT (4,5). were available as of 1 January 2008. We 1-h, 10.6 mmol/L; and 2-h, 8.9 mmol/L. There are limited data on the extent restricted the study cohort to birth events to which current practice guidelines for that occurred after 1 October 2008 to al- Statistical Analysis the screening for GDM are implemented low for a complete 9-month assessment We calculated the rates of GDM screen- in clinical practice at the population for gestational screening prior to delivery ing, overall and for each type of test (GDS, level. Accordingly, we evaluated the for all patients. Since screening for GDM is 75-g OGTT without GDS, HbA1c without prevalence, type, and timing of screen- recommended by 28 completed weeks of GDS or 75-g OGTT, and fasting or random ing for GDM and examined temporal pregnancy, women who delivered prior to glucose without GDS, 75-g OGTT, or and geographic differences in a defined 29 gestational weeks were excluded. HbA1c), for our entire study cohort, as geographic area (the province of Al- Women with preexisting diabetes, identi- well as by maternal place of residence berta, Canada) with universal health fied from the APHP antepartum risk (urban or rural) and calendar year. Gesta- care. Our secondary objectives were to assessment, were also excluded. We tional time of GDS and 75-g OGTT was identify maternal risk factors for not un- confined our primary analysis to primip- determined based on the gestational dergoing GDM screening. arous women because we are aware age at time of delivery, the collection that it is the practice of some health date of the laboratory test, and the de- RESEARCH DESIGN AND METHODS care providers in Alberta to treat livery date. When several GDS or 75-g Ethics Statement women with a previous diagnosis of OGTTs were collected, only the earliest Ethics approval for this study was ob- GDM without laboratory retesting in GDS and earliest 75-g OGTT following tained from the University of Alberta in- subsequent pregnancies, since there is GDS within 270 days prior to delivery stitutional review board (Pro00020230). a known high recurrence rate (8). How- were considered in the analysis. The ever, with this caveat in mind, we year of pregnancy was selected as the Data Sources and Linkage did examine GDM screening rates for calendar year of the delivery date. The Maternal personal health care number the entire population (both primiparous delivery date was obtained from labora- was used to link data from a provincial and multiparous) in a secondary analysis. tory data. We examined temporal trends perinatal database, the Alberta Perinatal for screening between 2009 and 2012. Health Program (APHP), with laboratory Outcome Measures Statistical significance of temporal trends data made available by the Data Integra- The primary outcome measure of interest was assessed using a logistic regression tion Measurement and Reporting (DIMR) was the incidence of laboratory screening model with screening as outcome and unit of Alberta Health Services (http:// testing for GDM. A woman was consid- year as the only predictor. www.albertahealthservices.ca) for the ered as having had a GDM screening test Descriptive statistics, specifically mean time period of 1 January 2008 to 31 De- if she had any of the five types of tests for (SD)andmedian(interquartilerange cember 2012. The APHP (www.aphp.ca) glycemic assessment (GDS, 75-g OGTT, [IQR]) for continuous variables and per- captures maternal, obstetrical, and neo- HbA1c, and fasting or random glucose) centages for categorical variables, were natal clinical information from the provin- within 270 days before delivery date. At compared between screened and un- cial delivery record for all hospital and the time the study was conducted, na- screened women using univariate Stu- registered midwife-attended home births tional clinical practice guidelines recom- dent t tests, Kruskal-Wallis test, and x2 in the province of Alberta, Canada. DIMR mended that all pregnant women be test, respectively; all tests of significance holds a central repository of laboratory screened for GDM with a GDS at were two sided, with P values of ,0.05 data for Alberta reported by four regional 24–28 weeks’ gestation (first trimester, if considered significant.
Load more

Recommended publications
  • Type 1 Diabetes and Pregnancy
    Type 1 diabetes and pregnancy Information for patients 1 2 Contents How will diabetes affect my pregnancy? 4 How will diabetes affect my baby? 5 My antenatal care 6 Hypoglycaemia 9 Planning for your birth 12 After your baby is born 15 Nutrition and related issues 17 Diet and lifestyle Controlling your blood glucose levels with diet Fluid intake Fat in foods Calcium Iron Folic acid and diabetes Diabetic products Symptoms in pregnancy How much weight should I expect to put on? Physical activity Suitable snacks Additional information Breastfeeding and diabetes 31 What happens once my baby is born? 34 For the future 37 References and useful links 39 3 This booklet aims to tell you what care to expect during and after your pregnancy when you have diabetes. It will not answer every question you may have, so please write any concerns down and ask your midwife or doctor. We run a joint antenatal and diabetes clinic at Barnet Hospital and the Royal Free Hospital. We have a dedicated multidisciplinary team who will review you on a regular basis to provide advice and support throughout your pregnancy. The team consists of a consultant endocrinologist, obstetrician, diabetes specialist midwife, diabetes specialist nurse and a diabetes specialist dietitian. How will diabetes affect my pregnancy? With good pre-conception care and good diabetes control there is every chance of a successful pregnancy. As soon as your pregnancy is confirmed, you should attend the joint diabetes antenatal clinic. Here you will receive support and advice to enable you to obtain and maintain good control of your diabetes as early in your pregnancy as possible.
    [Show full text]
  • Diabetes and Planning for Pregnancy
    Form: D-5227 Diabetes and Planning for Pregnancy Information for women with diabetes and their families Read this booklet to learn about: • planning for pregnancy when you have diabetes • how your health care team can help • managing your blood sugar Why do I need to plan for my pregnancy if I have diabetes? Getting pregnant and having a healthy baby can be a very exciting time in your life. If you have diabetes, it’s very important to plan ahead so you are as healthy as possible and your pregnancy is safe. Not controlling your blood sugar levels before and during pregnancy can cause health problems for you and your baby: • High blood sugars during the first 3 months of your pregnancy can cause your baby to have problems developing and you to miscarry. • High blood sugars during your pregnancy can cause your baby to grow too large. This can be a health risk for you and your baby. • The changes that happen in your body during pregnancy can cause any problems you already have because of diabetes to become worse. Work together with your health care team so you can have the healthiest and safest pregnancy possible. Talk to them about birth control so you can prevent pregnancy until your blood sugars are controlled. Who are members of my health care team? Before getting pregnant, your health care team may include a: • diabetes nurse educator • dietitian • endocrinologist • obstetrician/gynecologist • family doctor • ophthalmologist • nephrologist • cardiologist 2 We may refer you to a team that specializes in diabetes and pregnancy. How do I prepare for pregnancy? 9 Tell your health care team you are planning to get pregnant at least 3 months before you start trying.
    [Show full text]
  • 14. Management of Diabetes in Pregnancy: Standards of Medical
    Diabetes Care Volume 42, Supplement 1, January 2019 S165 14. Management of Diabetes in American Diabetes Association Pregnancy: Standards of Medical Care in Diabetesd2019 Diabetes Care 2019;42(Suppl. 1):S165–S172 | https://doi.org/10.2337/dc19-S014 14. MANAGEMENT OF 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.
    [Show full text]
  • Myo-Inositol, Probiotics, and Micronutrient Supplementation
    Diabetes Care Volume 44, May 2021 1091 Myo-Inositol, Probiotics, and Keith M. Godfrey,1,2 Sheila J. Barton,1 Sarah El-Heis,1 Timothy Kenealy,3 Micronutrient Supplementation Heidi Nield,1 Philip N. Baker,4 Yap Seng Chong,5,6 Wayne Cutfield,3,7 From Preconception for Glycemia Shiao-Yng Chan,5,6 and NiPPeR Study Group* in Pregnancy: NiPPeR International Multicenter Double-Blind Randomized Controlled Trial Diabetes Care 2021;44:1091–1099 | https://doi.org/10.2337/dc20-2515 OBJECTIVE Better preconception metabolic and nutritional health are hypothesized to pro- mote gestational normoglycemia and reduce preterm birth, but evidence sup- 1MRC Lifecourse Epidemiology Unit, University porting improved outcomes with nutritional supplementation starting of Southampton, Southampton, U.K. CLIN CARE/EDUCATION/NUTRITION/PSYCHOSOCIAL preconception is limited. 2NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS RESEARCH DESIGN AND METHODS Foundation Trust, Southampton, Southampton, U.K. This double-blind randomized controlled trial recruited from the community 3Liggins Institute, University of Auckland, 1,729 U.K., Singapore, and New Zealand women aged 18–38 years planning con- Auckland, New Zealand 4 ception. We investigated whether a nutritional formulation containing myo-inosi- College of Life Sciences, Biological Sciences and Psychology, University of Leicester, tol, probiotics, and multiple micronutrients (intervention), compared with a Leicester, U.K. standard micronutrient supplement (control), taken preconception and through- 5Department of Obstetrics and Gynaecology, out pregnancy could improve pregnancy outcomes. The primary outcome was Yong Loo Lin School of Medicine, National combined fasting, 1-h, and 2-h postload glycemia (28 weeks’ gestation oral glu- University of Singapore and National University Health System, Singapore cose tolerance test).
    [Show full text]
  • Hyperglycemia and Pregnancy in the Americas
    HYPERGLYCEMIA AND PREGNANCY IN THE AMERICAS Final report of the Pan American Conference on Diabetes and Pregnancy Lima (Peru), 8-10 September 2015 HYPERGLYCEMIA AND PREGNANCY IN THE AMERICAS Final report of the Pan American Conference on Diabetes and Pregnancy Lima (Peru), 8-10 September 2015 Washington, D.C., 2016. Also published in Spanish (2016): Hiperglucemia y embarazo en las Américas: Informe final de la Conferencia Panamericana sobre Diabetes y Embarazo (Lima, Perú. 8-10 de setiembre del 2015) ISBN 978-92-75-31883-6 PAHO HQ Library Cataloguing-in-Publication Data ****************************************************************************************************** Pan American Health Organization. Hyperglycemia and Pregnancy in the Americas. Final report of the Pan American Conference on Diabetes and Pregnancy (Lima Peru: 8-10 September 2015). Washington, DC : PAHO. 2016 1. Diabetes Mellitus. 2. Hyperglycemia. 3. Pregnancy. 4. Pregnancy in Diabetics. 5. Maternal and Child Health. 6. Americas. I. Title. ISBN 978-92-75-11883-2 (NLM Classification:WQ248) © Pan American Health Organization, 2016. All rights reserved. The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Communications Department, Pan American Health Organization, Washington, D.C., U.S.A. (www.paho.org/permissions). The Department of Noncommunicable Diseases and Mental Health will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention.
    [Show full text]
  • Combined Analysis of Gestational Diabetes and Maternal Weight
    www.nature.com/scientificreports OPEN Combined analysis of gestational diabetes and maternal weight status from pre‑pregnancy through post‑delivery in future development of type 2 diabetes Ling‑Wei Chen1,13, Shu E Soh1,2,13, Mya‑Thway Tint1,3, See Ling Loy4,5, Fabian Yap5,6, Kok Hian Tan5,7, Yung Seng Lee1,2,8, Lynette Pei‑Chi Shek1,2,8, Keith M. Godfrey9, Peter D. Gluckman1,10, Johan G. Eriksson1,3,11,12, Yap‑Seng Chong1,3 & Shiao‑Yng Chan1,3* We examined the associations of gestational diabetes mellitus (GDM) and women’s weight status from pre‑pregnancy through post‑delivery with the risk of developing dysglycaemia [impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (T2D)] 4–6 years post‑delivery. Using Poisson regression with confounder adjustments, we assessed associations of standard categorisations of prospectively ascertained pre‑pregnancy overweight and obesity (OWOB), gestational weight gain (GWG) and substantial post‑delivery weight retention (PDWR) with post‑delivery dysglycaemia (n = 692). Women with GDM had a higher risk of later T2D [relative risk (95% CI) 12.07 (4.55, 32.02)] and dysglycaemia [3.02 (2.19, 4.16)] compared with non‑GDM women. Independent of GDM, women with pre‑pregnancy OWOB also had a higher risk of post‑delivery dysglycaemia. Women with GDM who were OWOB pre‑pregnancy and had subsequent PDWR (≥ 5 kg) had 2.38 times (1.29, 4.41) the risk of post‑delivery dysglycaemia compared with pre‑pregnancy lean GDM women without PDWR. No consistent associations were observed between GWG and later dysglycaemia risk.
    [Show full text]
  • Living with Diabetes While Pregnant Blood Sugar Ranges Diabetes out of Balance for Gestational Diabetes – Pregnancy
    Living with Diabetes WHILE PREGNANT Approved by Glycemic Oversight Committee 12/12/17 Table of Contents What Is Gestational Diabetes .................... 2 Symptoms Of Low Blood Sugar .............. 13 What Can Happen To My Baby ................. 2 Insulin Therapy In Pregnancy .................. 14 Blood Sugar Ranges For How Your Insulin Works .......................... 14 Gestational Diabetes ................................. 3 Drawing And Injecting One Insulin ......... 15 Diabetes Out Of Balance, Mixing, Drawing And Injecting Insulin .... 16 Low And High Blood Sugar ....................... 3 Preparing And Injecting Insulin Requirement During Pregnancy ..... 4 With A Reusable Pen ............................... 17 Insulin Resistance In Site Selection And Rotation ..................... 18 Gestational Diabetes ................................. 4 Proper Use And Disposal ......................... 18 Dietary Guidelines For Gestational Diabetes ................................. 5 Sick Day Management ............................ 19 Carbohydrate Counting ........................... 6 Sick Day Food List ................................... 19 Examples Of Carbohydrates Morning Sickness .................................... 19 For Carb Counting .................................... 7 Ideas To Make You Feel Better ................. 19 Foods Low In Carbohydrates ..................... 8 Coping With Heartburn .......................... 20 Non Carbohydrate Foods.......................... 8 What Is Preterm Labor ............................ 20 Nutrition
    [Show full text]
  • Maternal Diabetes and Pregnancy
    Maternal Diabetes and Pregnancy Pregnancy Risk Assessment Monitoring System Hospital Discharge Data Data Highlights Maternal Diabetes and Pregnancy • Overall, 13.1% of mothers with a recent live birth have Diabetes is a common chronic condition with significant diabetes health effects. Traditionally, it has been associated with older individuals, although diabetes related to • Diabetes was high in mothers who indicated a race of pregnancy has also been of interest due to the impact Other Asian, Chinese, Filipino, Korean, Other Pacific on a pregnancy. Infants of diabetic mothers may Islander, Samoan, Japanese, and Hawaiian face serious health consequences, such as low birth weight, preterm delivery, macrosomia, and increased • Mothers > 35 years of age, those with some college risk for congenital anomalies.1,2 Additionally, mothers education, self-pay insurance, and those living in with diabetes are more likely to have complications Hawai‘i County had the highest estimates 1,2 necessitating a cesarean delivery during childbirth. • Mothers with diabetes were more likely to have a Women diagnosed with gestational diabetes have a seven-fold greater risk of developing chronic diabetes cesarean delivery, a preterm delivery, and have high later in life, compared to those who did not have blood pressure during pregnancy gestational diabetes.3 Even those with just an abnormal • Mothers with diabetes were more likely to report glucose screen in pregnancy (but normal follow up symptoms suggestive of postpartum depression and testing for gestational diabetes) are at increased risk fair/poor general health status for development of diabetes later in life.4 The American Diabetes Association recommends screening six to • Mothers with diabetes had higher hospital charges for twelve weeks postpartum and then every three years to both mother and infant identify those who develop chronic diabetes as early as possible.
    [Show full text]
  • Pregnancy Toolkit
    Pregnancy Toolkit Take care! Pregnancy or planning a pregnancy with type 1 diabetes (T1D) requires special consideration to help ensure a healthy outcome for mother and child. This guide provides information for parents-to-be or future parents-to-be with T1D—explaining the disease management goals for pregnancy and reviewing how to obtain the best possible support from healthcare providers at every stage. Pregnancy Toolkit | 1 Table of Contents Introduction and Goal of This Guide ........... 1 • Emotional fluctuations ...........................................24 • Missing those ZZZs! ................................................24 Chapter 1: The Decision .............................. 3 • Anxiety and stress ................................................... 25 • When is the right time for a baby? ........................3 • Still need to manage T1D ..................................... 25 • What are some factors to consider? ......................3 • Feeling alone? ........................................................... 25 • Pre-pregnancy goals ..................................................3 • The long, but joyous, haul .....................................26 Chapter 2: Conception ............................... 4 Chapter 9: Planning for the Future .......... 26 • An unplanned pregnancy: considerations ..........5 • As they grow .............................................................. 27 • Conception misconceptions ....................................5 • Education ..................................................................
    [Show full text]
  • Ibm Micromedex® Carenotes Titles by Category
    IBM MICROMEDEX® CARENOTES TITLES BY CATEGORY DECEMBER 2019 © Copyright IBM Corporation 2019 All company and product names mentioned are used for identification purposes only and may be trademarks of their respective owners. Table of Contents IBM Micromedex® CareNotes Titles by Category Allergy and Immunology ..................................................................................................................2 Ambulatory.......................................................................................................................................3 Bioterrorism ...................................................................................................................................18 Cardiology......................................................................................................................................18 Critical Care ...................................................................................................................................20 Dental Health .................................................................................................................................22 Dermatology ..................................................................................................................................23 Dietetics .........................................................................................................................................24 Endocrinology & Metabolic Disease ..............................................................................................26
    [Show full text]
  • Gestational Diabetes Screening and Treatment Guideline
    Gestational Diabetes Screening and Treatment Guideline Major Changes as of September 2021 ......................................................................................................... 2 Screening and Treatment Flowchart ............................................................................................................. 3 Screening Recommendations and Tests ...................................................................................................... 4 Diagnosis....................................................................................................................................................... 4 Treatment Goals ...................................................................................................................................................... 5 Lifestyle modifications/non-pharmacologic options ................................................................................ 5 Pharmacologic options ........................................................................................................................... 6 Additional Testing/Monitoring Antenatal monitoring ............................................................................................................................... 8 Follow-up after delivery .......................................................................................................................... 8 Referral .........................................................................................................................................................
    [Show full text]
  • Pre-Existing Diabetes and Pregnancy Potential Effects of Uncontrolled Diabetes Before and During Pregnancy
    Pre-Existing Diabetes and Pregnancy Potential Effects of Uncontrolled Diabetes Before and During Pregnancy If you have diabetes and want to get pregnant, it is important for you to get and keep your blood sugar in control (meaning your Hemoglobin A1c level is within the limits set by your health care provider). Working to keep your blood sugar in control before and during pregnancy increases your chances of having a healthy baby and reduces the chances that you will have other problems. Uncontrolled diabetes increases the chances for the following problems you and your baby: For You For more information, visit: • Worsening of any • Gestational diabetes factsheet: www.cdc.gov/diabetes/pubs/pdf/gestationalDiabetes.pdf existing eye, kidney, • Diabetes and Pregnancy web pages: heart, or nerve problems www.cdc.gov/Features/DiabetesAndPregnancy/ caused by diabetes • Labor may start too For Your Baby early (preterm labor) • Bladder and other • Birth defects infections ° Some heart defects • Gum disease ° Some major birth defects of the brain • Injury from delivering and spinal cord big baby • Stillbirth or • Cesarean section miscarriage • High blood pressure • Born very big (more than 9 pounds); • Preeclampsia (high if a big baby is blood pressure + delivered vaginally, it protein in urine) may have: ° Injury to nerves in Remember shoulder Working to control your blood sugar can help prevent these problems. ° Broken collarbone If you have diabetes, • Low blood sugar • Plan your pregnancy, if possible, and get your body ready before you get pregnant after birth • Eat healthy foods and stay active • Take your medicines • Yellow skin and eyes • Monitor your blood sugar often (jaundice) • Control and treat blood sugar right away • Obesity later in life • Follow up with the doctor regularly If you’ve never had a diabetes test and want to learn more about the symptoms, please visit www.cdc.gov/diabetes/consumer/learn.htm.
    [Show full text]