Diabetic Retinopathy In Pregnancy: A Population-based Study Of Women With Pregestational Diabetes
Diabetic Retinopathy in Pregnancy: A Population-Based Study of Women with Pregestational Diabetes 1Galway Diabetes Research Centre, National University of Ireland Galway and University Hospital Galway, Newcastle, Galway, Ireland 2Department of Ophthalmology, National University of Ireland Galway and University Hospital Galway, Newcastle, Galway, Ireland Received 17 February 2015; Revised 25 March 2015; Accepted 26 March 2015 Copyright 2015 Aoife M. Egan et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The aim of this observational study was to evaluate screening and progression of diabetic retinopathy during pregnancy in women with pregestational diabetes attending five antenatal centres along the Irish Atlantic seaboard. An adequate frequency of screening was defined as at least two retinal evaluations in separate trimesters. Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of diabetic macular edema on at least one eye. Women with pregestational diabetes who delivered after 22 gestational weeks ( ) were included. In total, 185 (60.3%) had an adequate number of retinal examinations. Attendance at prepregnancy care was associated with receiving adequate screening (odds ratio 6.23; CI 3.3911.46 ( )). Among those who received adequate evaluations ( ), 48 (25.9%) had retinopathy progression. Increasing booking systolic blood pressure (OR 1.03, CI 1.011.06, ) and greater drop in HbA1c between first and third trimesters of pregnancy (OR 2.05, CI 1.093.87, ) significantly increased the odds of progression. A significant proportion of women continue Continue reading >>
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- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
Contemporary Management Of Type 1 Diabetes Mellitus In Pregnancy
Type 1 diabetes in pregnancy can result in significant short- and long-term morbidity to both mother and offspring if management is suboptimal. This morbidity imposes a considerable financial and health burden on the individual and society at large. There is currently a significant body of knowledge to offer guidance on optimal obstetric management of the woman with type 1 diabetes. Utilization of appropriate management guidelines preconception and during pregnancy is an effective strategy to limit complications of type 1 diabetes and should therefore become the standard of care. Targrt Audience:Obstetricians & Gynecologists, Family Physicians Learning Objectives:After completion of this article, the reader should be able to describe the features of a type I diabetic patient, to outline the goals of preconception care in this population of patients, to list the potential adverse effects of diabetes in pregnancy, and to summarize a potential strategy for the management of insulin administration in pregnancy. Assistant Professor of Obstetrics and Gynecology, New York University School of Medicine, and Director, North Shore Center for Diabetes in Pregnancy, Division of MaternalFetal Medicine, North Shore-Long Island Jewish Health System, North Shore University Hospital, Manhasset, New York CHIEF EDITOR'S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credit hours can be earned in 2004. Instructions for how CME credits can be earned appear on the last page of the Table of Contents. Reprint requests to: James Bernasko, MD, Director, North Shore Center for Diabetes in Pregnancy, Division of MaternalFetal Medicine, North Shore-Long Island Jewish Health System, North Shore University Hosp Continue reading >>
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Diabetes Mellitus And Pregnancy
Initiate testing early enough to avoid significant stillbirth but not so early that a high rate of false-positive test results is encountered. In patients with poor glycemic control, intrauterine growth restriction, or significant hypertension, begin formal biophysical testing as early as 28 weeks. In patients who are at lower risk, most centers begin formal fetal testing by 34 weeks. Fetal movement counting is performed in all pregnancies from 28 weeks onward. There is no consensus regarding antenatal testing in patients with gestational diabetes that is well controlled with diet. Monitoring fetal growth continues to be a challenging and imprecise process. Although currently available tools (serial plotting of fetal growth parameters based on ultrasonographic measurement) are superior to those used previously for clinical estimations, accuracy is still only within 15%. [ 95 ] In the obese fetus, the inaccuracies are further magnified. In 1992, Bernstein and Catalano reported that significant correlation exists between the degree of error in the ultrasonogram-based estimation of fetal weight and the percentage of body fat on the fetus. [ 96 ] Perhaps this is the reason no single formula has proven to be adequate in identifying a macrosomic fetus with certainty. Despite problems with accuracy, ultrasonogram-based estimations of fetal size have become the standard of care. Estimate fetal size once or twice at least 3 weeks apart in order to establish a trend. Time the last examination to be at 36-37 weeks' gestation or as close to the planned delivery date as possible. Select the timing of delivery to minimize morbidity for the mother and fetus. Delaying delivery to as near as possible to the expected date of confinement helps maximize cervical maturity and improves the Continue reading >>
- Women in India with Gestational Diabetes Mellitus Strategy (WINGS): Methodology and development of model of care for gestational diabetes mellitus (WINGS 4)
- Diabetes and Pregnancy: Fluctuating Hormones and Glucose Management
- Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials
Diabetic Retinopathy Ppp - Updated 2017
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE The prevalence of diabetes, both worldwide and in the United States, is increasing; as such, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy (VTDR) is also expected to increase dramatically. Currently, only about 60% of people with diabetes have yearly screenings for diabetic retinopathy. People with Type 1 diabetes should have annual screenings for diabetic retinopathy beginning 5 years after the onset of their disease, whereas those with Type 2 diabetes should have a prompt examination at the time of diagnosis and at least yearly examinations thereafter. Maintaining near-normal glucose levels and near-normal blood pressure lowers the risk of retinopathy developing and/or progressing, so patients should be informed of the importance of maintaining good glycosylated hemoglobin levels, serum lipids, and blood pressure. Patients with diabetes may use aspirin for other medical indications without an adverse effect on their risk of diabetic retinopathy. Women who develop gestational diabetes do not require an eye examination during pregnancy and do not appear to be at increased risk of developing diabetic retinopathy during pregnancy. However, patients with diabetes who become pregnant should be examined early in the course of the pregnancy. Referral to an ophthalmologist is required when there is any nonproliferative diabetic retinopathy, proliferative retinopathy, or macular edema. Ophthalmologists should communicate both ophthalmologic findings and level of retinopathy to the primary care physician. They should emphasize to the patient the need to adhere to the primary care physicians guidance to optimize metabolic control. Intravitreal injections of anti-vascular endothelial growth fac Continue reading >>
Diabetic Retinopathy
Diabetic retinopathy, also known as diabetic eye disease, is when damage occurs to the retina due to diabetes. It can eventually lead to blindness. It is an ocular manifestation of diabetes, a systemic disease, which affects up to 80 percent of all patients who have had diabetes for 10 years or more. Despite these intimidating statistics, research indicates that at least 90% of these new cases could be reduced if there were proper and vigilant treatment and monitoring of the eyes. The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy. Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness for people aged 20 to 64 years. In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes. Undiagnosed: Of the 29.1 million, 21.0 million were diagnosed, and 8.1 million were undiagnosed. Prevalence in Seniors: The percentage of Americans age 65 and older remains high, at 25.9%, or 11.8 million seniors (diagnosed and undiagnosed). New Cases: The incidence of diabetes in 2012 was 1.7 million new diagnoses/year; in 2010 it was 1.9 million. Prediabetes: In 2012, 86 million Americans age 20 and older had pre diabetes, this is up from 79 million in 2010. Deaths: Diabetes remains the 7th leading cause of death in the United States in 2010, with 69,071 death certificates listing it as the underlying cause of death, and a total of 234,051 death certificates listing diabetes as an underlying or contributing cause of death. Light mask treatment is designed to be worn at night, to deliver a precise dose of light therapy during a patient?s normal hours of sleep. It comes in Continue reading >>
Do I Have Preeclampsia Quiz
do i have preeclampsia quiz If a pregnant woman does have preeclampsia, her blood pressure will Am I in Labor Checklist & Quiz; Weeks of Pregnancy; Preparing for Pregnancy; You might have heard it call PIH, but preeclampsia is the name of choice at this I'm a first timer and found out at 34 that i have preeclampsia. Do you know key elements of presentation, workup, and treatment? I HAVE RECENTLY READ - Serum test for prediction of preeclampsia (January 2016) Serum test for prediction of preeclampsia (January 2016) The ratio of soluble fmslike tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is increased in the serum of women with preeclampsia; however, the clinical application for this observation remains unclear. During the checkup, the healthcare practitioner will do a physical exam and perform laboratory tests to look for the "silent" signs of pre-eclampsia, like high blood pressure and protein in the urine. Preeclampsia and eclampsia develop after 20 wk gestation; up to 25% of cases develop postpartum, most often within the first 4 days but sometimes up to 6 wk postpartum. Sometimes a pain under the right-side rib cage is common, because thats where the liver is. According to the Preeclampsia Foundation, preeclampsia poses the following risks to babies : Symptoms of preeclampsia can include headaches, high blood pressure, swollen ankles protein in the urine, dizziness, shortness of breath and blurry vision. Question What is the association between maternal preeclampsia and retinopathy of prematurity (ROP) in with an increased risk of retinopathy of prematurity. They're also at higher risk for stroke later in life and develop cerebrovascular disease earlier than women with no history of preeclampsia. Fortunately, preeclampsia is easily found during routi Continue reading >>
Ppt Diabetic Retinopathy In Pregnancy Powerpoint Presentation | Free To View - Id: 20c959-zty4y
After you enable Flash, refresh this webpage and the presentation should play. PPT Diabetic Retinopathy in Pregnancy PowerPoint presentation | free to view - id: 20c959-ZTY4Y The Adobe Flash plugin is needed to view this content Laser photocoagulation is now the standard of care ... Photocoagulation may reduce the level of Vascular Endothelial Growth Factor ... PowerPoint PPT presentation 150,000 deaths per year from diabetes related 12,000 people lose their sight each year due to Diabetic retinopathy is the leading cause of blindness in women between the ages of 24 and 65. Also contains hyaluronic acid and collagen Composed of a chain of three neurons in ten layers First lesion of diabetic retinopathy seen with an Outpouching of retinal capillaries appear as red Can be seen as early as two years after the onset Caused with shunt and collateral vessel formation Retinal neovascularization is likely stimulated Untreated neovascular proliferation may lead to vitreous hemorrhage and retinal detachment Microaneurysms as early as two years after onset After 15 years- 98 of patients will have at After 25 years- virtually 100 of patients will Negligible risk of retinopathy in women with Minimal risk of retinopathy in women with IDDM Primary etiologic factor Chronic hyperglycemia Structural changes are identical in both pregnant Lack of intracellular glucose for glycolysis in (Insufficient glucose transport in the absence of Activated by excessive extracellular glucose Aldose reductase converts glucose to D-sorbitol Intracellular polyol sugars increase osmotic Osmotic insult causes thickening of the basement Prolonged activation of the polyol pathway leads Pericyte loss leads to weakening of the capillary Weakened capillary walls cause microaneurysm and New blood vessels bud in Continue reading >>
Retina Today - The Effect Of Pregnancy On Diabetic Retinopathy (january/february 2012)
The Effect of Pregnancy on Diabetic Retinopathy In an era of super-sizing and increasing obesity, theincidence of diabetes mellitus (DM) is approachingpandemic proportions. Approximately 6.3% of theUnited States and 4% of the world population haveDM.1 Diabetic retinopathy (DR) affects about half of allpeople with DM and is the leading cause of visual lossand new-onset blindness in the United States for thoseages 20 through 74 years.2 Proliferative diabeticretinopathy (PDR) is a major cause of preventable andpotentially irreversible vision loss. Given long enoughduration of DM, approximately 60% of patients willdevelop PDR; without intervention, nearly half of eyeswith PDR will experience profound visual loss.3 DM is preexisting in about 1% of all pregnancies inthe United States. In the setting of pregnancy, hormonaland systemic insults can accelerate microvascular diabeticdamage. Progression of DR during pregnancy canbe rapid with potentially devastating consequences forthe patient and baby. In these high-risk patients, screeningfor DR with prompt intervention for PDR beforeconception as well as during and after pregnancy is criticalfor optimal patient outcomes.4 RISK FACTORS FOR DR PROGRESSIONDURING PREGNANCY Four factors have been identified that influence therisk and rate of progression of DR during pregnancy. Worse metabolic control at conception predicts ahigher rate of progression of DR. Interestingly, however,a greater magnitude of improvement in glycemic controlduring pregnancy has been correlated with a higherrisk of DR progression;5 therefore, ideally female diabeticsof childbearing age should achieve normoglycemia(HbA1c < 7%) at least 6-8 months prior to conception. More severe DR at the time of conception increasesthe risk of worsening DR, as was shown in t Continue reading >>
Ada Guidelines Diabetes In Pregnancy Gdm | Ndei
Diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life Maintain A1C levels as close to normal as is safely possible Ideally, A1C <6.5% (48 mmol/L) without hypoglycemia Prescribe effective contraception until woman is prepared to become pregnant Women with preexisting type 1 or type 2 diabetes Counsel on the risk of development and/or progression of diabetic retinopathy Perform eye exams before pregnancy or in first trimester; monitor every trimester and for 1 year postpartum Insulin is the preferred medication for pregestational type 1 and type 2 diabetes not adequately controlled with diet, exercise, and metformin Insulin* management during pregnancy is complex Requires frequent titration to match changing requirements Referral to specialized center recommended Women with type 1 diabetes are at high risk for hypoglycemia Hypoglycemia education important before and during pregnancy to prevent hypoglycemia Women with type 1 diabetes are at risk for ketoacidosis At lower blood glucose levels than in the nonpregnant state Provide education on prevention and treatment of diabetic ketoacidosis Women with type 2 diabetes are at risk for obesity Recommended weight gain during pregnancy: 15-25 lb overweight, 10-20 lb obese Glycemic control easier to achieve than in type 1 but can require higher insulin doses 1-hr postprandial 130-140 mg/dL (7.2-7.8 mmol/L) *Most insulins are category B; glargine, glulisine, and degludec are category C Recommendations for Gestational Diabetes Mellitus (GDM) GDM increases the risk of macrosomia, birth complications, and maternal diabetes after pregnancy Risks increase with progressive hyperglycemia Risk may be reduced with diet, physical activity, and lifestyle counseling Medical nutrition, physical Continue reading >>
Reference
This purpose of this talk is to overview the 2017 American Diabetes Association Standards of Medical Care in Diabetes. These Standards comprise all of the current and key clinical practice recommendations of the American Diabetes Association. [SLIDE] 2 Reference American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014;37(suppl 1):S1 A few notes on the Standards of Care: The Association funds development of the Standards of Care and all Association position statements out of its general revenues and does not use industry support for these purposes [CLICK] The slides are organized to correspond with sections within the 2017 Standards of Care. As we go through I’ll make note of where we are within the document. [CLICK] Though not every section in the document is represented, these slides do incorporate the most salient points from the Position Statement As with all Association position statements, the Standards of Care are reviewed and approved by the Association’s Board of Directors, which includes health care professionals, scientists, and lay people. [SLIDE] 3 These Standards of Care are revised annually by the ADA’s multidisciplinary Professional Practice Committee (PPC) [CLICK] For the 2017 revision, PPC members systematically searched Medline for human studies related to each subsection and published since 1 January 2016. [CLICK] Recommendations were revised based on new evidence or, in some cases, to clarify the prior recommendations or match the strength of the word to the strength of the evidence [CLICK] A table linking the changes in the recommendations to new evidence can be reviewed at professional.diabetes.org/SOC (Standards of Care) [CLICK] The Association and the Professional Practice Committee Continue reading >>
Progression Of Proliferative Diabetic Retinopathy During Pregnancy
Progression of Proliferative Diabetic Retinopathy During Pregnancy Mackenzie Treloar, BS, BA; C. Nathaniel Roybal, MD, PhD; Philip I. Niles, MD, MBA ; Stephen R. Russell, MD Chief Complaint: "My vision is much worse since my delivery." One week after an otherwise uncomplicated cesarian section, a G2P2 24-year-old woman with type 1 diabetes was evaluated by the University of Iowa Retina Service for decreased vision and multiple new floaters in both eyes. She identified the onset of dramatically decreased vision in both eyes that began at the time of the delivery of her most recent child. During the patient's first pregnancy three years prior, her previously diagnosed severe non-proliferative diabetic retinopathy progressed to proliferative diabetic retinopathy with new-onset vitreous hemorrhage and she developed clinically significant diabetic macular edema in the left eye. To avoid fetal exposure to anti-vascular endothelial growth factor (anti-VEGF), anti-VEGF injections were withheld at that time, and the patient was instead treated with panretinal photocoagulation. Given her high risk for ocular complications, the patient had been closely monitored by the Retina Service throughout the first trimester of this second pregnancy; however, she was lost to follow-up thereafter. Uncontrolled diabetes type I (last HbA1c of 14.1%) complicated by prior episodes of diabetic ketoacidosis and acute pancreatitis Figure 2: Color fundus photographs taken 7 months prior to pregnancy for comparison. OD: Neovascularization of the disc with preretinal hemorrhage anterior to the macula and throughout the inferior and temporal periphery with moderate panretinal photocoagulation scars diffusely OS: Areas of preretinal hemorrhage inferiorly, dot blot hemorrhages throughout the periphery in Continue reading >>
Diabetic Retinopathy And The Effect Of Pregnancy
Diabetic Retinopathy and the Effect of Pregnancy 1. Department of Ophthalmology, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysia (Mallika Premsenthil, Tan Aik Kah) 1. Department of Ophthalmology, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysia (Mallika Premsenthil, Tan Aik Kah) 2. Department of Ophthalmology, Sarawak General Hospital, Kuching, Sarawak, Malaysia (Mohamad Aziz Salowi, Asokumaran Thanaraj, Intan Gudom) 2. Department of Ophthalmology, Sarawak General Hospital, Kuching, Sarawak, Malaysia (Mohamad Aziz Salowi, Asokumaran Thanaraj, Intan Gudom) 3. Department of Family Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Malaysia (Syed Alwi Syed Abdul Rahman) 1. Department of Ophthalmology, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysia (Mallika Premsenthil, Tan Aik Kah) 1. Department of Ophthalmology, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysia (Mallika Premsenthil, Tan Aik Kah) 2. Department of Ophthalmology, Sarawak General Hospital, Kuching, Sarawak, Malaysia (Mohamad Aziz Salowi, Asokumaran Thanaraj, Intan Gudom) 3. Department of Family Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Malaysia (Syed Alwi Syed Abdul Rahman) Dr Mallika Premsenthil, Lecturer, Ophthalmology Unit, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Lot 77, Seksyen 22 Kuching Town Land District, Jalan Tun Ahmad Zaidi Adruce, 93150 Kuching, Sarawak, Malaysia. Tel: +6082 416550, Fax: +6082 422564, Email: ym.saminu.shmf@akillamp Pregnancy is associated with increased risk of development and progression of dia Continue reading >>
Diabetes Mellitus | Williams Obstetrics, 24e | Accessmedicine | Mcgraw-hill Medical
According to the National Center for Health Statistics (2013) , the number of adults diagnosed with diabetes in the United States has tripled from 6.9 million in 1991 to 20.9 million in 2011. Astoundingly, the Centers for Disease Control and Prevention (2010) have estimated that the number of Americans with diabetes will range from 1 in 3 to 1 in 5 by 2050. Reasons for this rise include an aging population more likely to develop type 2 diabetes, increases in minority groups at particular risk for type 2 diabetes, and dramatic increases in obesityalso referred to as diabesity. This term reflects the strong relationship of diabetes with the current obesity epidemic in the United States and underlines the critical need for diet and lifestyle interventions to change the trajectory of both. There is keen interest in events that precede diabetes, and this includes the uterine environment, where early imprinting is believed to have effects later in life ( Saudek, 2002 ). For example, in utero exposure to maternal hyperglycemia leads to fetal hyperinsulinemia, causing an increase in fetal fat cells. This leads to obesity and insulin resistance in childhood ( Feig, 2002 ). This in turn leads to impaired glucose tolerance and diabetes in adulthood. This cycle of fetal exposure to diabetes leading to childhood obesity and glucose intolerance has been reported in Pima Indians and a heterogeneous Chicago population ( Silverman, 1995 ). In nonpregnant individuals, the type of diabetes is based on its presumed etiopathogenesis and its pathophysiological manifestations. Absolute insulin deficiency characterizes type 1 diabetes. In contrast, defective insulin secretion, insulin resistance, or increased glucose production characterizes type 2 diabetes ( Table 57-1 ). Both types are gene Continue reading >>
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- American Diabetes Association® Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes
Watch Out For Diabetic Retinopathy
During Healthy Vision Month each May, Americans are urged to make eye health a priority. Take a few minutes to learn about diabetic retinopathy, the most common form of diabetes-related eye disease and the leading cause of blindness in working-age Americans. Taking an active role in managing your diabetes can help prevent vision loss from diabetic retinopathy. Diabetic retinopathy is one of several common eye diseases , but is the most common cause of vision impairment and blindness among working-age adults in the United States. From 2010 to 2050, the number of Americans with diabetic retinopathy is expected to nearly double, from 7.7 million to 14.6 million. Diabetic retinopathy occurs when diabetes affects the blood vessels in the retina (the light-sensitive tissue in the back of the eye), causing them to leak and distort vision. If not found and treated early, diabetic retinopathy can cause permanent vision loss. Diabetic retinopathy may not have any symptoms in the early stages. So if you have diabetes, be sure to schedule a comprehensive dilated eye exam once a year. Diabetic retinopathy can be diagnosed and treated before you notice any vision problems. Symptoms that could indicate that the disease has progressed to a more advanced stage include: Anyone with type 1 or type 2 diabetes, or women who had diabetes during pregnancy (gestational diabetes), can develop diabetic retinopathy. The risk increases the longer a person has diabetes and when blood sugar, blood pressure, and cholesterol levels are hard to control. Healthy eating can reduce your risk for diabetic retinopathy. There are simple steps you can take to keep your eyes healthy and make sure youre seeing your best. Taking an active role in managing your diabetes is critical: Make healthy eating and physi Continue reading >>
Diabetes Mellitus In Pregnancy
(Gestational Diabetes; Pregestational Diabetes) By Lara A. Friel, MD, PhD, Associate Professor, Maternal-Fetal Medicine Division, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Medical School at Houston, McGovern Medical School Pregnancy aggravates preexisting type 1 ( insulin-dependent) and type 2 (non insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy, nephropathy, or neuropathy ( 1 ). Gestational diabetes (diabetes that begins during pregnancy [ 2 ]) can develop in overweight, hyperinsulinemic, insulin-resistant women or in thin, relatively insulin-deficient women. Gestational diabetes occurs in at least 5% of all pregnancies, but the rate may be much higher in certain groups (eg, Mexican Americans, American Indians, Asians, Indians, Pacific Islanders). Women with gestational diabetes are at increased risk of type 2 diabetes in the future. Diabetes during pregnancy increases fetal and maternal morbidity and mortality. Neonates are at risk of respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, and hyperviscosity. Poor control of preexisting (pregestational) or gestational diabetes during organogenesis (up to about 10 wk gestation) increases risk of the following: Poor control of diabetes later in pregnancy increases risk of the following: Fetal macrosomia (usually defined as fetal weight > 4000 g or > 4500 g at birth) However, gestational diabetes can result in fetal macrosomia even if blood glucose is kept nearly normal. Guidelines for managing diabetes mellitus during pregnancy are available from the American College of Obstetricians and Gynecologists (ACOG [ 1 , 2 ]). 1. Committee on Practice BulletinsObstetrics : ACOG Practice Bulletin No. 60: Clinical man Continue reading >>
