Diabetes and Pregnancy
Diabetes and Pregnancy
Our objective was to formulate a clinical practice guideline for the management of the pregnant woman with diabetes.
The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee of The Endocrine Society, 5 additional experts, a methodologist, and a medical writer.
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.
One group meeting, several conference calls, and innumerable e-mail communications enabled consensus for all recommendations save one with a majority decision being employed for this single exception.
Using an evidence-based approach, this Diabetes and Pregnancy Clinical Practice Guideline addresses important clinical issues in the contemporary management of women with type 1 or type 2 diabetes preconceptionally, during pregnancy, and in the postpartum setting and in the diagnosis and management of women with gestational diabetes during and after pregnancy.
This continuing medical education activity should be of substantial interest to endocrinologists and other health care professionals that treat patients with diabetic patients during pregnancy and postpartum.
Upon completion of this educational activity, learners will be able to:
- Recognize the appropriate target level of glycemic control (as reflected by the HbA1C) for a woman with established diabetes before attempting to conceive.
- Evaluate self-monitored blood glucose target levels for a woman with gestational diabetes and the appropriate therapeutic intervention if these targets are being exceeded.
- Determine the appropriate frequency for ocular assessment for a pregnant woman with diabetes and known retinopathy.
- Select appropriate antihyperglycemic medication for a breastfeeding woman with type 2 diabetes.
STATEMENT OF INDEPENDENCE
As a provider of continuing medical education (CME) accredited by the Accreditation Council for Continuing Medical Education, The Endocrine Society has a policy of ensuring that the content and quality of this educational activity are balanced, independent, objective, and scientifically rigorous. The scientific content of this activity was developed under the supervision of The Diabetes and Pregnancy Guidelines Task Force.
The faculty, committee members, and staff who are in position to control the content of this activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are related to the CME content. Financial relationships are defined by remuneration in any amount from the commercial interest(s) in the form of grants; research support; consulting fees; salary; ownership interest (e.g., stocks, stock options, or ownership interest excluding diversified mutual funds); honoraria or other payments for participation in speakers' bureaus, advisory boards, or boards of directors; or other financial benefits. The intent of this disclosure is not to prevent CME planners with relevant financial relationships from planning or delivery of content, but rather to provide learners with information that allows them to make their own judgments of whether these financial relationships may have influenced the educational activity with regard to exposition or conclusion.
The Endocrine Society has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.
The following task force members who planned and/or reviewed content for this activity reported relevant financial relationships:
Ian Blumer, MD (chair) is a speaker for Astra-Zeneca, Bristol Myers Squibb, Eli Lilly, Medtronic, Novo Nordisk, Roche and Sanofi-Aventis. He is also a member of advisory board for Bayer, Eli Lilly, GlaxoSmithKline, Novo Nordisk, Janssen Pharmaceuticals, and Takeda.
David R. Hadden, MD is a member of the data monitoring committee for Novo Nordisk and a technical editor for Wiley-Blackwell Publishing.
The following committee members who planned and/or reviewed content for this activity reported no relevant financial relationships: M. Hassan Murad, MD; Lois Jovanovič, MD; Jorge H. Mestman, MD; Eran Hadar, MD; Yariv Yogev, MD
Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.
Use of professional judgment:
The educational content in this activity relates to basic principles of diagnosis and therapy and does not substitute for individual patient assessment based on the health care provider’s examination of the patient and consideration of laboratory data and other factors unique to the patient. Standards in medicine change as new data become available.
Drugs and dosages:
When prescribing medications, the physician is advised to check the product information sheet accompanying each drug to verify conditions of use and to identify any changes in drug dosage schedule or contraindications.
POLICY ON UNLABELED/OFF-LABEL USE
The Endocrine Society has determined that disclosure of unlabeled/off-label or investigational use of commercial product(s) is informative for audiences and therefore requires this information to be disclosed to the learners at the beginning of the presentation. Uses of specific therapeutic agents, devices, and other products discussed in this educational activity may not be the same as those indicated in product labeling approved by the Food and Drug Administration (FDA). The Endocrine Society requires that any discussions of such “off-label” use be based on scientific research that conforms to generally accepted standards of experimental design, data collection, and data analysis. Before recommending or prescribing any therapeutic agent or device, learners should review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.
PRIVACY AND CONFIDENTIALITY STATEMENT
The Endocrine Society will record learner's personal information as provided on CME evaluations to allow for issuance and tracking of CME certificates. The Endocrine Society may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its CME program. No individual performance data or any other personal information collected from evaluations will be shared with third parties.
ACKNOWLEDGEMENT OF COMMERCIAL SUPPORT
This activity is not supported by educational grant(s) from commercial supporters.
- 2.00 AMA PRA Category 1 Credits™
- 2.00 CME Certificate of Participation