October 2005 · Vol. 17, No. 10Current management of diabetic pregnancy
Unlike conventional therapy, intensive drug therapy plus self-monitoring diminishes adverse obstetric outcomes in all types of diabetes
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Fast Track
I advise 20 to 30 minutes of exercise 3 to 4 times weekly, if women are willing and able, as it can improve postprandial blood glucose levels and insulin sensitivity
In my opinion, insulin lispro can and should be used in pregnancy because it produces more physiologic insulin patterns
Hypoglycemic episodes occurred in 63% of insulin-treated women with gestational diabetes, but in only 28% of women taking glyburide
Compromised lung maturity in a live infant is preferable to healthy lungs in a deceased infant
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Oded
Langer,
MD, PhDChairman, Department of Obstetrics and Gynecology, St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University,
New York City
New agents such as insulin analogs (mainly insulin lispro) and oral antidiabetic drugs (mainly glyburide) have profoundly altered the management of diabetes, producing obstetric outcomes comparable to those among the general population. Furthermore, in all types of diabetes, self-monitoring of blood glucose plus intensified drug therapy may help women achieve glycemic control and enhance perinatal outcomes at a lower cost than conventional management—and patients readily accept this approach.
This article describes the rationale for intensive treatment with these agents and other interventions to prevent both hypoglycemia and hyperglycemia.
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