This document presents consensuspanel recommendations for themedical care of pregnant womenwith preexisting diabetes, including type1 and type 2 diabetes. The intent is to helpclinicians deal with the broad spectrum ofproblems that arise in management of diabetesbefore and during pregnancy, andto prepare diabetic women for treatmentthat may reduce complications in theyears after pregnancy. A thorough discussionof the evidence supporting the recommendationsis presented in the book,Management of Preexisting Diabetes andPregnancy, authored by the consensuspanel and published by the AmericanDiabetes Association (ADA) in 2008 (1).A consensus statement on obstetricaland postpartum management will appearseparately.

 

      The recommendations are diagnosticand therapeutic actions that are known orbelieved to favorably affect maternal andperinatal outcomes in pregnancies complicatedby diabetes. The grading systemadapted by the ADA was used to clarifyand codify the evidence that forms thebasis for the recommendations (2). Unfortunatelythere is a paucity of randomizedcontrolled trials (RCTs) of the differentaspects of management of diabetes andpregnancy. Therefore our recommendationsare often based on trials conductedin nonpregnant diabetic women or nondiabeticpregnant women, as well as onpeer-reviewed experience before and duringpregnancy in women with preexistingdiabetes (3–4). We also reviewed andadapted existing diabetes and pregnancyguidelines (5–10) and guidelines on diabetescomplications and comorbidities(2,3,11–14).