UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Pregestational diabetes mellitus: Obstetrical issues and management

Author
Jeffrey L Ecker, MD
Section Editor
Michael F Greene, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

The key elements in management of pregnancies complicated by diabetes are:

Achieving and maintaining excellent glycemic control

Screening, monitoring, and intervention for maternal medical complications (eg, retinopathy, nephropathy, hypertension, cardiovascular disease, ketoacidosis, thyroid disease)

Monitoring of, and intervention for, fetal and obstetrical complications (eg, congenital anomalies, preeclampsia, macrosomia)

Most issues related to the obstetrical management of a pregnant diabetic woman (type 1 or type 2) will be reviewed here. The obstetrical management of these pregnancies is largely based upon clinical experience, data from observational studies, and expert opinion [1,2]. There is virtually no evidence from randomized trials.

                                           

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Nov 16 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Pregestational Diabetes Mellitus. ACOG Practice Bulletin Number 60. American College of Obstetricians and Gynecologists, Washington, DC 2005.
  2. Gabbe SG, Graves CR. Management of diabetes mellitus complicating pregnancy. Obstet Gynecol 2003; 102:857.
  3. White P. Classification of obstetric diabetes. Am J Obstet Gynecol 1978; 130:228.
  4. Diamond MP, Salyer SL, Vaughn WK, et al. Reassessment of White's classification and Pedersen's prognostically bad signs of diabetic pregnancies in insulin-dependent diabetic pregnancies. Am J Obstet Gynecol 1987; 156:599.
  5. Bennett SN, Tita A, Owen J, et al. Assessing White's classification of pregestational diabetes in a contemporary diabetic population. Obstet Gynecol 2015; 125:1217.
  6. Sacks DA, Metzger BE. Classification of diabetes in pregnancy: time to reassess the alphabet. Obstet Gynecol 2013; 121:345.
  7. Cormier CM, Martinez CA, Refuerzo JS, et al. White's classification of diabetes in pregnancy in the 21st century: is it still valid? Am J Perinatol 2010; 27:349.
  8. Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2013; 98:4227.
  9. Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. Diabetes Care 2000; 23:1084.
  10. American Diabetes Association. 12. Management of Diabetes in Pregnancy. Diabetes Care 2016; 39 Suppl 1:S94.
  11. Pedersen JF, Mølsted-Pedersen L. Early growth retardation in diabetic pregnancy. Br Med J 1979; 1:18.
  12. Brown ZA, Mills JL, Metzger BE, et al. Early sonographic evaluation for fetal growth delay and congenital malformations in pregnancies complicated by insulin-requiring diabetes. National Institute of Child Health and Human Development Diabetes in Early Pregnancy Study. Diabetes Care 1992; 15:613.
  13. Reece EA, Quintela PA, Homko CJ, Sivan E. Early fetal growth delay: is it really predictive of congenital anomalies in infants of diabetic women? J Matern Fetal Med 1997; 6:168.
  14. Mulder EJ, Visser GH. Impact of early growth delay on subsequent fetal growth and functional development: a study on diabetic pregnancy. Early Hum Dev 1992; 31:91.
  15. American College of Obstetricians and Gynecologists. Hypertension in pregnancy http://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy (Accessed on November 15, 2016).
  16. Campbell KH, Savitz D, Werner EF, et al. Maternal morbidity and risk of death at delivery hospitalization. Obstet Gynecol 2013; 122:627.
  17. Rosenberg TJ, Garbers S, Lipkind H, Chiasson MA. Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among 4 racial/ethnic groups. Am J Public Health 2005; 95:1545.
  18. Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto. QJM 2001; 94:347.
  19. Bo S, Menato G, Signorile A, et al. Obesity or diabetes: what is worse for the mother and for the baby? Diabetes Metab 2003; 29:175.
  20. Bartsch E, Medcalf KE, Park AL, et al. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016; 353:i1753.
  21. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication (Accessed on November 15, 2016).
  22. Greene MF, Hare JW, Cloherty JP, et al. First-trimester hemoglobin A1 and risk for major malformation and spontaneous abortion in diabetic pregnancy. Teratology 1989; 39:225.
  23. Miller E, Hare JW, Cloherty JP, et al. Elevated maternal hemoglobin A1c in early pregnancy and major congenital anomalies in infants of diabetic mothers. N Engl J Med 1981; 304:1331.
  24. Ylinen K, Aula P, Stenman UH, et al. Risk of minor and major fetal malformations in diabetics with high haemoglobin A1c values in early pregnancy. Br Med J (Clin Res Ed) 1984; 289:345.
  25. Macintosh MC, Fleming KM, Bailey JA, et al. Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 2006; 333:177.
  26. Siegel AM, Tita A, Biggio JR, Harper LM. Evaluating gestational weight gain recommendations in pregestational diabetes. Am J Obstet Gynecol 2015; 213:563.e1.
  27. Scifres CM, Feghali MN, Althouse AD, et al. Effect of excess gestational weight gain on pregnancy outcomes in women with type 1 diabetes. Obstet Gynecol 2014; 123:1295.
  28. Egan AM, Dennedy MC, Al-Ramli W, et al. ATLANTIC-DIP: excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab 2014; 99:212.
  29. Yee LM, Cheng YW, Inturrisi M, Caughey AB. Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines. Am J Obstet Gynecol 2011; 205:257.e1.
  30. Parellada CB, Asbjörnsdóttir B, Ringholm L, et al. Fetal growth in relation to gestational weight gain in women with type 2 diabetes: an observational study. Diabet Med 2014; 31:1681.
  31. Milunsky A, Alpert E, Kitzmiller JL, et al. Prenatal diagnosis of neural tube defects. VIII. The importance of serum alpha-fetoprotein screening in diabetic pregnant women. Am J Obstet Gynecol 1982; 142:1030.
  32. Ray JG, Vermeulen MJ, Meier C, Wyatt PR. Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes. QJM 2004; 97:651.
  33. Evans MI, Harrison HH, O'Brien JE, et al. Correction for insulin-dependent diabetes in maternal serum alpha-fetoprotein testing has outlived its usefulness. Am J Obstet Gynecol 2002; 187:1084.
  34. Langer O. Ultrasound biometry evolves in the management of diabetes in pregnancy. Ultrasound Obstet Gynecol 2005; 26:585.
  35. Starikov R, Bohrer J, Goh W, et al. Hemoglobin A1c in pregestational diabetic gravidas and the risk of congenital heart disease in the fetus. Pediatr Cardiol 2013; 34:1716.
  36. Odibo AO, Coassolo KM, Stamilio DM, et al. Should all pregnant diabetic women undergo a fetal echocardiography? A cost-effectiveness analysis comparing four screening strategies. Prenat Diagn 2006; 26:39.
  37. Sekhavat S, Kishore N, Levine JC. Screening fetal echocardiography in diabetic mothers with normal findings on detailed anatomic survey. Ultrasound Obstet Gynecol 2010; 35:178.
  38. Jaeggi ET, Fouron JC, Proulx F. Fetal cardiac performance in uncomplicated and well-controlled maternal type I diabetes. Ultrasound Obstet Gynecol 2001; 17:311.
  39. Greene MF, Benacerraf BR. Prenatal diagnosis in diabetic gravidas: utility of ultrasound and maternal serum alpha-fetoprotein screening. Obstet Gynecol 1991; 77:520.
  40. Albert TJ, Landon MB, Wheller JJ, et al. Prenatal detection of fetal anomalies in pregnancies complicated by insulin-dependent diabetes mellitus. Am J Obstet Gynecol 1996; 174:1424.
  41. Philipps AF, Porte PJ, Stabinsky S, et al. Effects of chronic fetal hyperglycemia upon oxygen consumption in the ovine uterus and conceptus. J Clin Invest 1984; 74:279.
  42. Cohn HE, Cohen WR, Piasecki GJ, Jackson BT. The effect of hyperglycemia on acid-base and sympathoadrenal responses in the hypoxemic fetal monkey. J Dev Physiol 1992; 17:299.
  43. Shelley HJ, Bassett JM, Milner RD. Control of carbohydrate metabolism in the fetus and newborn. Br Med Bull 1975; 31:37.
  44. Robillard JE, Sessions C, Kennedy RL, Smith FG Jr. Metabolic effects of constant hypertonic glucose infusion in well-oxygenated fetuses. Am J Obstet Gynecol 1978; 130:199.
  45. Hay WW Jr, DiGiacomo JE, Meznarich HK, et al. Effects of glucose and insulin on fetal glucose oxidation and oxygen consumption. Am J Physiol 1989; 256:E704.
  46. Nylund L, Lunell NO, Lewander R, et al. Uteroplacental blood flow in diabetic pregnancy: measurements with indium 113m and a computer-linked gamma camera. Am J Obstet Gynecol 1982; 144:298.
  47. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 60, March 2005. Pregestational diabetes mellitus. Obstet Gynecol 2005; 105:675.
  48. Landon MB, Vickers S. Fetal surveillance in pregnancy complicated by diabetes mellitus: is it necessary? J Matern Fetal Neonatal Med 2002; 12:413.
  49. Kjos SL, Leung A, Henry OA, et al. Antepartum surveillance in diabetic pregnancies: predictors of fetal distress in labor. Am J Obstet Gynecol 1995; 173:1532.
  50. Signore C, Freeman RK, Spong CY. Antenatal testing-a reevaluation: executive summary of a Eunice Kennedy Shriver National Institute of Child Health and Human Development workshop. Obstet Gynecol 2009; 113:687.
  51. Lagrew DC, Pircon RA, Towers CV, et al. Antepartum fetal surveillance in patients with diabetes: when to start? Am J Obstet Gynecol 1993; 168:1820.
  52. Siddiqui F, James D. Fetal monitoring in type 1 diabetic pregnancies. Early Hum Dev 2003; 72:1.
  53. Lampl M, Jeanty P. Exposure to maternal diabetes is associated with altered fetal growth patterns: A hypothesis regarding metabolic allocation to growth under hyperglycemic-hypoxemic conditions. Am J Hum Biol 2004; 16:237.
  54. Menon RK, Cohen RM, Sperling MA, et al. Transplacental passage of insulin in pregnant women with insulin-dependent diabetes mellitus. Its role in fetal macrosomia. N Engl J Med 1990; 323:309.
  55. Alexander GR, Himes JH, Kaufman RB, et al. A United States national reference for fetal growth. Obstet Gynecol 1996; 87:163.
  56. ACOG Practice Bulletin #22: Fetal Macrosomia. Reaffirmed 2013.
  57. Acker DB, Barss VA. Obstetrical complications. In: Diabetes Complication Pregnancy, 2nd ed, Brown FM, Hare JW (Eds) (Eds), Wiley-Liss, New York 1995. p.153.
  58. Modanlou HD, Komatsu G, Dorchester W, et al. Large-for-gestational-age neonates: anthropometric reasons for shoulder dystocia. Obstet Gynecol 1982; 60:417.
  59. Benedetti TJ, Gabbe SG. Shoulder dystocia. A complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery. Obstet Gynecol 1978; 52:526.
  60. Langer O, Berkus MD, Huff RW, Samueloff A. Shoulder dystocia: should the fetus weighing greater than or equal to 4000 grams be delivered by cesarean section? Am J Obstet Gynecol 1991; 165:831.
  61. Ecker JL, Greenberg JA, Norwitz ER, et al. Birth weight as a predictor of brachial plexus injury. Obstet Gynecol 1997; 89:643.
  62. Dildy GA, Clark SL. Shoulder dystocia: risk identification. Clin Obstet Gynecol 2000; 43:265.
  63. Neufeld ND, Scott M, Kaplan SA. Ontogeny of the mammalian insulin receptor. Studies of human and rat fetal liver plasma membranes. Dev Biol 1980; 78:151.
  64. Greco P, Vimercati A, Scioscia M, et al. Timing of fetal growth acceleration in women with insulin-dependent diabetes. Fetal Diagn Ther 2003; 18:437.
  65. Ben-Haroush A, Chen R, Hadar E, et al. Accuracy of a single fetal weight estimation at 29-34 weeks in diabetic pregnancies: can it predict large-for-gestational-age infants at term? Am J Obstet Gynecol 2007; 197:497.e1.
  66. Scioscia M, Vimercati A, Ceci O, et al. Estimation of birth weight by two-dimensional ultrasonography: a critical appraisal of its accuracy. Obstet Gynecol 2008; 111:57.
  67. Combs CA, Rosenn B, Miodovnik M, Siddiqi TA. Sonographic EFW and macrosomia: is there an optimum formula to predict diabetic fetal macrosomia? J Matern Fetal Med 2000; 9:55.
  68. Shepard MJ, Richards VA, Berkowitz RL, et al. An evaluation of two equations for predicting fetal weight by ultrasound. Am J Obstet Gynecol 1982; 142:47.
  69. Conway DL. Delivery of the macrosomic infant: cesarean section versus vaginal delivery. Semin Perinatol 2002; 26:225.
  70. Holmes VA, Young IS, Patterson CC, et al. Optimal glycemic control, pre-eclampsia, and gestational hypertension in women with type 1 diabetes in the diabetes and pre-eclampsia intervention trial. Diabetes Care 2011; 34:1683.
  71. Sibai BM, Caritis S, Hauth J, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol 2000; 182:364.
  72. Innes KE, Wimsatt JH, McDuffie R. Relative glucose tolerance and subsequent development of hypertension in pregnancy. Obstet Gynecol 2001; 97:905.
  73. Joffe GM, Esterlitz JR, Levine RJ, et al. The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1998; 179:1032.
  74. Savvidou MD, Geerts L, Nicolaides KH. Impaired vascular reactivity in pregnant women with insulin-dependent diabetes mellitus. Am J Obstet Gynecol 2002; 186:84.
  75. Dashe JS, Nathan L, McIntire DD, Leveno KJ. Correlation between amniotic fluid glucose concentration and amniotic fluid volume in pregnancy complicated by diabetes. Am J Obstet Gynecol 2000; 182:901.
  76. Biggio JR Jr, Wenstrom KD, Dubard MB, Cliver SP. Hydramnios prediction of adverse perinatal outcome. Obstet Gynecol 1999; 94:773.
  77. Sibai BM, Caritis SN, Hauth JC, et al. Preterm delivery in women with pregestational diabetes mellitus or chronic hypertension relative to women with uncomplicated pregnancies. The National institute of Child health and Human Development Maternal- Fetal Medicine Units Network. Am J Obstet Gynecol 2000; 183:1520.
  78. Greene MF, Hare JW, Krache M, et al. Prematurity among insulin-requiring diabetic gravid women. Am J Obstet Gynecol 1989; 161:106.
  79. Mimouni F, Miodovnik M, Siddiqi TA, et al. High spontaneous premature labor rate in insulin-dependent diabetic pregnant women: an association with poor glycemic control and urogenital infection. Obstet Gynecol 1988; 72:175.
  80. Reece EA, Sivan E, Francis G, Homko CJ. Pregnancy outcomes among women with and without diabetic microvascular disease (White's classes B to FR) versus non-diabetic controls. Am J Perinatol 1998; 15:549.
  81. Fisher JE, Smith RS, Lagrandeur R, Lorenz RP. Gestational diabetes mellitus in women receiving beta-adrenergics and corticosteroids for threatened preterm delivery. Obstet Gynecol 1997; 90:880.
  82. Bedalov A, Balasubramanyam A. Glucocorticoid-induced ketoacidosis in gestational diabetes: sequela of the acute treatment of preterm labor. A case report. Diabetes Care 1997; 20:922.
  83. Mathiesen ER, Christensen AB, Hellmuth E, et al. Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: test of an algorithm [correction of analgoritm]. Acta Obstet Gynecol Scand 2002; 81:835.
  84. Refuerzo JS, Garg A, Rech B, et al. Continuous glucose monitoring in diabetic women following antenatal corticosteroid therapy: a pilot study. Am J Perinatol 2012; 29:335.
  85. Gyamfi-Bannerman C, Thom EA, Blackwell SC, et al. Antenatal Betamethasone for Women at Risk for Late Preterm Delivery. N Engl J Med 2016; 374:1311.
  86. Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery http://www.ajog.org/article/S0002-9378(16)00475-0/pdf (Accessed on November 16, 2016).
  87. Consortium on Safe Labor, Hibbard JU, Wilkins I, et al. Respiratory morbidity in late preterm births. JAMA 2010; 304:419.
  88. Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009; 360:111.
  89. Bates E, Rouse DJ, Mann ML, et al. Neonatal outcomes after demonstrated fetal lung maturity before 39 weeks of gestation. Obstet Gynecol 2010; 116:1288.
  90. Robert MF, Neff RK, Hubbell JP, et al. Association between maternal diabetes and the respiratory-distress syndrome in the newborn. N Engl J Med 1976; 294:357.
  91. Piper JM, Xenakis EM, Langer O. Delayed appearance of pulmonary maturation markers is associated with poor glucose control in diabetic pregnancies. J Matern Fetal Med 1998; 7:148.
  92. Torday J, Carson L, Lawson EE. Saturated phosphatidylcholine in amniotic fluid and prediction of the respiratory-distress syndrome. N Engl J Med 1979; 301:1013.
  93. Kjos SL, Berkowitz KM, Kung B. Prospective delivery of reliably dated term infants of diabetic mothers without determination of fetal lung maturity: comparison to historical control. J Matern Fetal Neonatal Med 2002; 12:433.
  94. Mølsted-Pedersen L, Kühl C. Obstetrical management in diabetic pregnancy: the Copenhagen experience. Diabetologia 1986; 29:13.
  95. Spong CY, Mercer BM, D'alton M, et al. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118:323.
  96. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121:908.
  97. Rasmussen MJ, Firth R, Foley M, Stronge JM. The timing of delivery in diabetic pregnancy: a 10-year review. Aust N Z J Obstet Gynaecol 1992; 32:313.
  98. Rayburn WF. Prostaglandin E2 gel for cervical ripening and induction of labor: a critical analysis. Am J Obstet Gynecol 1989; 160:529.
  99. Lawrence RD, Oakley W. Pregnancy and diabetes. Quart J Med 1941; 11:45.
  100. DRISCOLL JJ, GILLESPIE L. OBSTETRICAL CONSIDERATIONS IN DIABETES IN PREGNANCY. Med Clin North Am 1965; 49:1025.
  101. HAGBARD L. Pregnancy and diabetes mellitus; a clinical study. Acta Obstet Gynecol Scand Suppl 1956; 35:1.
  102. PEDOWITZ P, SHLEVIN EL. REVIEW OF MANAGEMENT OF PREGNANCY COMPLICATED BY DIABETES AND ALTERED CARBOHYDRATE METABOLISM. Obstet Gynecol 1964; 23:716.
  103. McElvy SS, Miodovnik M, Rosenn B, et al. A focused preconceptional and early pregnancy program in women with type 1 diabetes reduces perinatal mortality and malformation rates to general population levels. J Matern Fetal Med 2000; 9:14.
  104. Girz BA, Divon MY, Merkatz IR. Sudden fetal death in women with well-controlled, intensively monitored gestational diabetes. J Perinatol 1992; 12:229.
  105. Kjos SL, Henry OA, Montoro M, et al. Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management. Am J Obstet Gynecol 1993; 169:611.
  106. McCall JO. Shoulder dystocia: A study of after effects. Am J Obstet Gynecol 1962; 83:1486.
  107. Acker DB, Sachs BP, Friedman EA. Risk factors for shoulder dystocia. Obstet Gynecol 1985; 66:762.
  108. Golditch IM, Kirkman K. The large fetus. Management and outcome. Obstet Gynecol 1978; 52:26.
  109. Rouse DJ, Owen J, Goldenberg RL, Cliver SP. The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. JAMA 1996; 276:1480.
  110. Wladimiroff JW, Bloemsma CA, Wallenburg HC. Ultrasonic diagnosis of the large-for-dates infant. Obstet Gynecol 1978; 52:285.
  111. Practice Bulletin No. 173: Fetal Macrosomia. Obstet Gynecol 2016; 128:e195.
  112. ACOG Committee on Practice Bulletins-Gynecology, The American College of Obstetrician and Gynecologists. ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists. Number 40, November 2002. Obstet Gynecol 2002; 100:1045.
  113. Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 1998; 179:476.
  114. Cormier CM, Landon MB, Lai Y, et al. White's classification of maternal diabetes and vaginal birth after cesarean delivery success in women undergoing a trial of labor. Obstet Gynecol 2010; 115:60.
  115. Gabbe SG, Mestman JH, Freeman RK, et al. Management and outcome of pregnancy in diabetes mellitus, classes B to R. Am J Obstet Gynecol 1977; 129:723.
  116. Olofsson P, Ingemarsson I, Solum T. Fetal distress during labour in diabetic pregnancy. Br J Obstet Gynaecol 1986; 93:1067.
  117. Datta S, Brown WU Jr. Acid-base status in diabetic mothers and their infants following general or spinal anesthesia for cesarean section. Anesthesiology 1977; 47:272.
  118. ACOG committee opinion #363; Breastfeeding: maternal and fetal aspects. February 2007.
  119. Kozhimannil KB, Pereira MA, Harlow BL. Association between diabetes and perinatal depression among low-income mothers. JAMA 2009; 301:842.
  120. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016; 65:1.
  121. American Diabetes Association. Preconception care of women with diabetes. Diabetes Care 2003; 26 Suppl 1:S91.
  122. Visser J, Snel M, Van Vliet HA. Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2. Cochrane Database Syst Rev 2013; :CD003990.
  123. Sibai BM, Viteri OA. Diabetic ketoacidosis in pregnancy. Obstet Gynecol 2014; 123:167.
  124. Carroll MA, Yeomans ER. Diabetic ketoacidosis in pregnancy. Crit Care Med 2005; 33:S347.
  125. Cullen MT, Reece EA, Homko CJ, Sivan E. The changing presentations of diabetic ketoacidosis during pregnancy. Am J Perinatol 1996; 13:449.
  126. Hagay ZJ, Weissman A, Lurie S, Insler V. Reversal of fetal distress following intensive treatment of maternal diabetic ketoacidosis. Am J Perinatol 1994; 11:430.