Managing diabetes during pregnancy. Guide for family physicians.
OBJECTIVE
To provide a guide family physicians can use to interpret current evidence on treating women with pregestational and gestational diabetes mellitus (GDM) and to develop a model for managing these patients.


METHODS
A MEDLINE search from January 1980 to December 2002 found randomized controlled trials (RCTs) and descriptive studies that had conflicting results regarding screening recommendations. Studies of intensive insulin therapy were predominantly large RCTs (level I evidence). Glycemic targets and guidelines for monitoring pregnant women are based primarily on consensus statements from large national societies.


RESULTS
Most pregnant women should be screened for GDM. Good glycemic control during pregnancy reduces congenital anomalies and stillbirths. Women failing to meet glycemic targets should be referred to multidisciplinary teams and considered for insulin therapy. Intensive insulin therapy reduces the risk of macrosomia and might reduce cesarean section rates and other serious outcomes.


CONCLUSIONS
Despite controversy, family physicians can follow a plan for managing diabetic patients during pregnancy that is supported by the best available evidence.
Sempowski
Ian P
IP
Department of Family Medicine, Queen's University, Kingston, Ont. sempowsk@post.queensu.ca
Houlden
R L
RL
D000328:Adult; D003920:Diabetes Mellitus / Q000188:drug therapy*; D016640:Diabetes, Gestational / Q000188:drug therapy*; D005194:Family Practice; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics; D012307:Risk Factors
D007004:Hypoglycemic Agents; D007328:Insulin