How do we go about if the sugar levels are high?

Education is the cornerstone of effective metabolic management of the patient with diabetes during pregnancy. Especially, trained and certified nurses and dietitians (diabetes educators) are the most effective in achieving this.

• Initial treatment for gestational diabetes should consist of lifestyle changes with regard to diet and fitness. If lifestyle changes cannot sufficiently control blood glucose, medications should be used. If 2-hour postprandial glucose levels are maintained below 120 mg/dL, approximately 20% of fetuses demonstrate macrosomia. If postprandial levels range up to 160 mg/dL, macrosomia rates rise to 35%. Pre-existing diabetes (type 1 or 2):

During the first trimester of pregnancy, women with diabetes should undergo testing (in addition to normal prenatal laboratory tests) for HbA1c, blood urea nitrogen, serum creatinine, thyroid-stimulating hormone, and free thyroxine levels, as well as spot urine protein-to-creatinine ratio and capillary blood sugar levels 4–5 times daily as feasible.

Second-trimester testing for women with diabetes includes a repeat spot urine protein-to-creatinine study in women with elevated value in first trimester, a repeat HbA1c, and capillary blood sugar levels 4–5 times daily. In the first trimester, patients should have an ultrasonogram assessment (including measurement of crown-rump length) for pregnancy dating and viability. Consider nuchal translucency if the fetus is at high risk for cardiac defects (e.g. because of high maternal glycosylated hemoglobin). In the second trimester, perform a detailed anatomy ultrasonogram at 18–20 weeks, and a fetal echocardiogram if the maternal glycosylated hemoglobin values were less than 8.5%. In the third trimester, perform a growth ultrasonogram to assess fetal size every 4–6 weeks from 26 weeks to 36 weeks in women with overt preexisting diabetes. Perform a growth ultrasonogram for fetal size at least once at 36–37 weeks for women with gestational diabetes mellitus. Consider performing this study more frequently if macrosomia is suggested. If maternal diabetes is longstanding or associated with known microvascular disease, obtain a baseline maternal electrocardiogram (ECG) and echocardiogram. If pre-eclampsia is suggested, order the following tests:

• 24-hour urine collection

• Blood urea nitrogen and serum creatinine

• Liver function tests

• Uric acid

• Complete blood cell count

• Assessment of fetal well-being with nonstress test, amniotic fluid index, fetal growth and Doppler ultrasonographic examination of the umbilical cord and middle cerebral artery.

An eye examination to look for diabetic retinopathy should be performed in women with type 1 or type 2 diabetes; if found, the retinopathy should be treated before conception. In patients with preexisting diabetes, nutritional and metabolic intervention must be initiated and screen for microvascular complications well before pregnancy begins, because birth defects occur during the critical 3–6 weeks after conception.