Global guideline on pregnancy and diabetes - International ...
Global guideline on pregnancy and diabetes - International ...
Global guideline on pregnancy and diabetes - International ...
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<str<strong>on</strong>g>Global</str<strong>on</strong>g> Guideline <strong>on</strong> Pregnancy <strong>and</strong> Diabetes<br />
Stop ACE inhibitors <strong>and</strong> ARBs <strong>and</strong> use appropriate substitutes.<br />
Stop statins, fibrates <strong>and</strong> niacin.<br />
Assess established <strong>diabetes</strong> complicati<strong>on</strong>s, especially of the eyes <strong>and</strong> kidneys; discuss<br />
<strong>and</strong> manage identified problems.<br />
At first prenatal visit<br />
For women with <strong>diabetes</strong> who have had pre-<strong>pregnancy</strong> counselling, review<br />
underst<strong>and</strong>ing of management of <strong>diabetes</strong> in <strong>pregnancy</strong>, current drug therapy,<br />
blood glucose c<strong>on</strong>trol, <strong>diabetes</strong> complicati<strong>on</strong>s, <strong>and</strong> presence of other medical<br />
c<strong>on</strong>diti<strong>on</strong>s. Advise as appropriate.<br />
For women with <strong>diabetes</strong> who may have missed pre-<strong>pregnancy</strong> counselling, determine<br />
HbA 1c<br />
as so<strong>on</strong> as practical, <strong>and</strong> offer advice <strong>on</strong> risk <strong>on</strong> the basis of the result.<br />
For women who are at high risk of <strong>diabetes</strong> because of previous GDM, provide<br />
healthy lifestyle advice <strong>and</strong> offer an OGTT as so<strong>on</strong> as practical. If the result is normal,<br />
then offer again at 26 to 28 weeks of gestati<strong>on</strong>. A <strong>on</strong>e-stage definitive procedure is<br />
preferred.<br />
For all other women (unless a selective process based <strong>on</strong> risk factors is deemed<br />
more appropriate), advise that they will be offered testing for GDM at 26 to 28<br />
weeks of gestati<strong>on</strong>.<br />
19<br />
Pregnancy_EN2.indd 19 16/09/09 15:42
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