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The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy

Aidan McElduff, N Wah Cheung, H David McIntyre, Janet A Lagström, Barry N J Walters, Jeremy J N Oats, Peter Wein, Glynis P Ross and David Simmons
Med J Aust 2005; 183 (7): 373-377.

Summary

  • Strict control of blood glucose levels should be pursued before conception and maintained throughout the pregnancy (glycohaemoglobin [HbA1c] level as close as possible to the reference range).

  • Before conception:

    • high-dose (5 mg daily) folate supplementation should be commenced;

    • oral hypoglycaemic agents should be ceased; and

    • diabetes complications screening should take place.

  • Management should be by a multidisciplinary team experienced in the management of diabetes in pregnancy.

  • Blood glucose monitoring is mandatory during pregnancy, and targets are: fasting 4.0–5.5 mmol/L; postprandial < 8.0 mmol/L at 1 hour; < 7 mmol/L at 2 hours.

  • A first trimester nuchal translucency (possibly with first trimester biochemical screening with pregnancy-associated plasma protein A and β-human chorionic gonadotropin) should be offered.

  • Ultrasound should be performed for fetal morphology at 18–20 weeks, if required, for cardiac views at 24 weeks and for fetal growth at 28–30 and 34–36 weeks.

  • Induction of labour or operative delivery should be based on obstetric and/or fetal indications.

  • Level 3 neonatal nursing facilities may be required and should be anticipated when birth occurs before 36 weeks, or if there has been poor glycaemic control.

  • Insulin requirements fall rapidly during labour and in the puerperium. At this time, close monitoring and adjustment of insulin therapy is necessary.

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  • Aidan McElduff1
  • N Wah Cheung2
  • H David McIntyre3
  • Janet A Lagström4
  • Barry N J Walters5
  • Jeremy J N Oats6
  • Peter Wein7
  • Glynis P Ross8
  • David Simmons9

  • 1 Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW.
  • 2 Centre for Diabetes and Endocrinology Research, Westmead Hospital, Westmead, NSW.
  • 3 Queensland Diabetes Centre, Mater Hospital, South Brisbane, QLD.
  • 4 King Edward Memorial Hospital, Perth, WA.
  • 5 Department of Obstetrics, Royal Women's Hospital, Melbourne, VIC.
  • 6 Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, NSW.
  • 7 Waikato Clinical School, University of Auckland, Waikato Hospital, Hamilton, New Zealand.

Correspondence: 

Competing interests:

David McIntyre has received speaker fees from Novo Nordisk Australia, Lilly Australia and Alphapharm, and has received assistance to attend meetings from Novo Nordisk Australia, Aventis and Lilly Australia.

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