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Pregestational diabetes

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Last update: 
September 22, 2009
Authors: 
Nancy Hendrix
Pregnancy Management

Antepartum testing

Ultrasounds: every 4 weeks after 18-20w anatomy scan
Antenatal fetal testing (for well-controlled DM*):
- NSTs starting at 32weeks
-- 32-35 6/7weeks: 1x/week
-- 36-39 6/7weeks: 2x/week
Deliver by EDC

*Well-controlled DM is usually defined as 2h-post-prandials <20% above 120mg/dL, and/or <10% fastings above 95mg/dL in 1 week.

If end-organ disease, poorly controlled diabetes or FGR (or other high risk for IUFD), consider starting weekly BPPs or NSTs at 28weeks, then NSTs 2x/week starting at 32weeks.

Consult

Type I/II Diabetes (648.03)
 glucometer/supplies:_______
 nutrition education: ________
 HgB A1C ______@_____wks
 TSH________
— Dip urine for protein every prenatal visit
— baseline creatinine
— Baseline 24°Urine
Total Protein_____Creat Cl_____@____wks
— EKG
— Ophth Exam
— Early fetal echo at ~14 wks: ______
repeat ~22wks ______
— Serial Growth Scans q4wks from anatomy scan
________@ ________ ________@ ________
________@ ________ ________@ ________
— NST’s weekly from 32 wks
— NST’s twice weekly from 36 wks