The grades of evidence (I-III) and levels of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
- Suspected fetal macrosomia is not an indication for induction of labor because induction does not improve maternal or fetal outcomes.
- Antepartum fetal monitoring, including fetal movement counting, the nonstress test, the biophysical profile, and the contraction stress test when performed at appropriate intervals, is a valuable approach and can be used to monitor the pregnancies of women with pregestational diabetes mellitus.
- Adequate maternal glucose control should be maintained near physiologic levels before conception and throughout pregnancy to decrease the likelihood of spontaneous abortion, fetal malformation, fetal macrosomia, intrauterine fetal death, and neonatal morbidity.
- Patients and their families should be taught how to respond quickly and appropriately to hypoglycemia.
- Preconceptional counseling for women with pregestational diabetes mellitus has been reported to be beneficial and cost-effective and should be encouraged.
- The use of oral agents for control of type 2 diabetes mellitus during pregnancy should be limited and individualized until data regarding the safety and efficacy of these drugs become available.
- To prevent traumatic birth injury, cesarean delivery may be considered if the estimated fetal weight is greater than 4,500 g in women with diabetes.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.