Section 13 – Management of Diabetes in Pregnancy
These are the updated guidelines from the 2017 ADA Standards of Care, Section 13 page S115.
Insulin treatment of Choice – insulin was emphasized as the treatment of choice in pregnancy based on the concerns about the concentration of metformin on the fetal side of the placenta and glyburide levels in cord blood.
Glucose testing and goals – based on evidence, more emphasis will be placed on post-prandial targets and less on pre-prandial values.
To simplify, fasting and postprandial targets are now the same for pregnant women with pre-existing diabetes and gestational diabetes.
Pregnancy and Blood Pressure Goals – for pregnant patients with diabetes and chronic hypertension, the new blood pressure target is 120-160/80-105 mmHg. This target is to optimize maternal health without causing fetal harm. Antihypertensive drugs known to be effective and safe in pregnancy include methyldopa, labetalol, diltiazem, clonidine, and prazosin.