Acrobat
MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Diabetes In Pregnancy Series
Sponsored by The Indian Health Service Clinical Support Center
PART 2: Management, delivery, and postpartum
13. I.H.S. on-line resources
For additional resources please go to 14 Other Online Resources.
A.C.O.G./I.H.S. Postgraduate Reference Text 2003 A.C.O.G. / I.H.S. Reference Text Online: Diabetes in Pregnancy, pp. 17-33 (pdf 130k)
UpToDate software
[Notes: Click on the link below, and then the Accept button on the screen that comes up.]
Screening
and diagnosis of gestational diabetes mellitus.
Lois Jovanovic, MD. UpToDate
software 10.3, 2002.
Treatment
and course of gestational diabetes mellitus.
Lois Jovanovic, MD.
UpToDate software 10.3, 2002.
Obstetrical
management of pregnancy complicated by diabetes mellitus.
Vanessa A Barss,
MD, Robert N Blatman, MD. UpToDate software 10.3, 2002.
Infant
of a diabetic mother.
Arieh Riskin, MD Peter M Haney, MD, PhD UpToDate software
10.3, 2002.
Triplet
pregnancy: Mid and late pregnancy complications and management.
David C Jones,
MD UpToDate software 10.3, 2002.
Cochrane Library
*'Human' insulin versus animal insulin in people with diabetes mellitus. Richter B, Neises G. (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update
*Elective delivery in diabetic pregnant women Boulvain M, Stan C, Irion O. (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
*Dietary regulation for 'gestational diabetes' Walkinshaw SA. (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
Implications for practice
Current evidence suggests little practical benefit for primary dietary therapy. However, the numbers in the trials analyzed are insufficient to examine important variables such as Caesarean section and birth injury. At present aggressive management of more minor degrees of carbohydrate intolerance cannot be justified without a research project.
*Elective delivery in diabetic pregnant women Boulvain M, Stan C, Irion O. (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
Implications for practice
There is very little evidence to support either elective delivery or expectant management at term in pregnant women with insulin-requiring diabetes. The results of the only randomized controlled trial evaluating elective delivery in term diabetic pregnant women suggested that there might be little advantage in delaying delivery beyond 38-39 weeks in insulin-requiring diabetic pregnant women. As the risk of macrosomia was reduced in the active management group, induction of labour might be a reasonable option for these women. The study was too small to assess the effect on perinatal mortality.
* Induction of labour for suspected fetal macrosomia Irion O, Boulvain M. (Cochrane Review).In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
Implications for practice
There is currently no evidence that a systematic policy of labour induction for suspected fetal macrosomia in non-diabetic women can reduce maternal or neonatal morbidity. However, limited information is available to evaluate this intervention.
* Very tight versus tight control for diabetes in pregnancy Walkinshaw SA. (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update Software.
Implications for practice
It is still uncertain how tightly controlled diabetes needs to be in pregnancy. Currently there seems little benefit to women in insisting on very tight control as defined in these trials. Clinicians who feel that such regimens are necessary should consider participating in appropriately designed trials.
* 'Human' insulin versus animal insulin in people with diabetes mellitus. Richter B, Neises G. (Cochrane Review). In: The Cochrane Library, Issue 1, 2003. Oxford: Update
Implications for practice
This review is in accordance with the findings of the systematic review of Airey et al. with respect to the absence of a differential effect on hypoglycaemia between human and animal insulin. For the first time though, this review aggregates the relative effects and adverse events of human and animal insulin, indicating that human insulin was introduced without proof of being superior to animal insulin. Moreover, studies have not assessed patient-centred outcomes like patient satisfaction, health-related quality of life, and diabetes-related morbidity. Furthermore, randomised trials did not report on qualitative assessments of patients' experiences when using different insulin species.
