Diabetes in Pregnancy: Preconception to Postpartum

The incidence of all diabetes types are increasing, including the rate of women with diabetes in pregnancy. Preconception counseling continues to be an important part of visits with women who have diabetes and those at risk for gestational diabetes. Intensive control of blood sugar reduces the risk of negative outcomes in mother and baby. Diet and insulin are the preferred treatments for diabetes in pregnancy. While metformin has shown benefits in pregnancy, its use is debated. Insulin dose adjustments are required to reach glycemic goals during pregnancy and tend to change throughout its course with higher doses needed with increasing insulin resistance in the second and third trimesters. Breastfeeding is encouraged for all women regardless of diabetes type. Insulin doses generally need adjustment after delivery due to placental delivery leading to decreased insulin and lactation increasing energy requirements.