What care is required from the physician for a Type diabetic pregnant woman without chronic complications

If the woman belongs to either B or C categories in the White classification (see Table 10.2), the following steps are required:

• Intensive self monitoring of blood glucose (4-7 measurements a day).

• Intensive insulin regimen using the classic rapid-acting insulins or insulin analogues and possibly continuous insulin infusion pumps.

• Glycaemic control targets: Fasting blood glucose 60-90 mg/dl (3.35.0 mmol/L) and two hours postprandially < 120 mg/dl (6.7 mmol/L).

• Regular clinic visits so that the doctor can adjust treatment and control blood glucose. Visits should be at the most every 15 days up to the 34th week of gestation and then weekly.

• HbAlc measurements every month.

• Regular ophthalmologic examinations at intervals depending on findings.

• Determination of 24-hour urinary protein excretion and creatinine clearance at initial visit and then quarterly.

• At labour, glucose level should be maintained below 90 mg/dl (5.0 mmol/L) with NaCl infusion together with insulin or/and glucose, based on blood glucose measurements every hour.

The American Diabetes Association also recommends the following obstetric monitoring:

• Level 2 ultrasound during the 18-22nd week and then every 4-6 weeks.

• Non-stress test at 32-34th week and then every week.

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