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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Preconception Counseling for Women with Diabetes and Hypertension
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Step 13. A C O G resources
ACOG Committee Opinion 313 September 2005
The Importance of Preconception Care in the Continuum of Women’s Health Care
ABSTRACT: The goal of preconception care is to reduce the risk of adverse health effects for the woman, fetus, or neonate by optimizing the woman's health and knowledge before planning and conceiving a pregnancy. Because reproductive capacity spans almost four decades for most women, optimizing women's health before and between pregnancies is an ongoing process that requires access to and the full participation of all segments of the health care system.
The importance of preconception care in the continuum of women's health care. ACOG Committee Opinion No. 313. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;106:665–6
ACOG Members
Non-ACOG members
ACOG Practice Bulletin #60, March 2005
Pregestational Diabetes Mellitus
Summary of Recommendations and Conclusions
The following recommendation is 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 pre-gestational 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.
Pregestational diabetes mellitus. ACOG Practice Bulletin No. 60. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;105:675–85.
ACOG Members
Non-ACOG Members
ACOG Practice Bulletin #29, July 2001
Chronic Hypertension in Pregnancy
Summary of Recommendations
The following recommendation is based on good and consistent scientific evidence (Level A):
- Angiotensin-converting enzyme inhibitors are contraindicated during pregnancy and are associated with fetal and neonatal renal failure and death
The following recommendation is based on limited or inconsistent scientific evidence (Level B):
- Antihypertensive therapy should be used for pregnant women with severe hypertension for maternal benefit.
- Methyldopa and labetalol are appropriate first-line antihypertensive therapies.
- Treatment of women with uncomplicated mild chronic hypertension is not beneficial because it does not improve perinatal outcome.
- The beta-blocker atenolol may be associated with growth restriction and is not recommended for use in pregnancy.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- Women with chronic hypertension should be evaluated for potentially reversible etiologies, preferably prior to pregnancy.
- Women with long-standing hypertension should be evaluated for end-organ disease, including cardiomegaly, renal insufficiency, and retinopathy, preferably prior to pregnancy.
- When chronic hypertension is complicated by IUGR or preeclampsia, fetal surveillance is warranted.
Chronic Hypertension in Pregnancy. ACOG Practice Bulletin No. 29. American College of Obstetricians and Gynecologists. Obstet Gynecol 2001; 98:177-185
ACOG Members
Non-ACOG Members
* ACOG Evidence grading system
The MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents were used to conduct a literature search to locate relevant articles published between January 1985 and October 2000. The search was restricted to articles published in the English language. Priority was given to articles reporting results of original research, although review articles and commentaries also were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion in this document.
Guidelines published by organizations or institutions such as the National Institutes of Health and the American College of Obstetricians and Gynecologists were reviewed, and additional studies were located by reviewing bibliographies of identified articles. When reliable research was not available, expert opinions from obstetrician–gynecologists were used. Studies were reviewed and evaluated for quality according to the method outlined by the U.S. Preventive Services Task Force:
- 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.
- I I-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.
Based on the highest level of evidence found in the data, recommendations are provided and graded according to the following categories:
- 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.
