Management of Type 2 Diabetes Mellitus* During Pregnancy

Before conception

Glycemic control

Risk is lowest if HbA1c levels are ≤ 6.5% at conception.†

Weight loss is encouraged if BMI is > 27 kg/m2.

The diet should be low in fat, relatively high in complex carbohydrates, and high in fiber.

Exercise is encouraged.

Prenatal

For women with overweight, diet and caloric intake are individualized and monitored to avoid weight gain of more than about 6.8–11.3 kg (> 15–25 lb) or, if they are obese, more than about 5–9.1 kg (> 11–20 lb).

Moderate walking after meals is recommended.

Women are instructed in and should do blood glucose self-monitoring.

The 2-hour postbreakfast blood glucose level is checked weekly at clinic visits if possible.

HbA1c level should be checked every trimester.

Antenatal testing with the following should be done from 32 weeks to delivery (or earlier if indicated):

• Nonstress tests (weekly)

• Biophysical profiles (weekly)

• Kick counts (daily)

Amount and type of insulin is individualized. For women with obesity, short-acting insulin is taken before each meal. For women who are not obese, two thirds of the total dose (60% NPH, 40% regular) is taken in the morning; one third (50% NPH, 50% regular) is taken in the evening. Or, women can take long-acting insulin once or twice a day and insulin aspart immediately before breakfast, lunch, and dinner.

During labor and delivery

Management is the same as for type 1 (see table Management of Type 1 Diabetes Mellitus During Pregnancy).