In addition to blood glucose control, a team approach to management of the diabetic gravida includes

• Nutritional consult for planning a diet

• Opthalmology consult to determine if there is any damage to the retina which might need laser treatment in women who were diabetic prior to pregnancy

• In women who already were diabetic before pregnancy, if kidney damage is suspected, or diabetes is long-standing, collection of a 24-hour urine for protein and creatinine clearance is indicated

• Drawing blood for a glycosylated hemoglobin (Hemoglobin A1C) to estimate risk of fetal anomalies

• Early and 18-20 week fetal ultrasound to detect anomalies

• Serial ultrasound measurements to detect macrosomia, growth restriction, oligohydramnios and polyhydramnios

• Fetal surveillance is crucial
  • In insulin-dependent diabetes, twice-weekly nonstress testing beginning at 32 weeks offers the best reassurance
  • Biophysical profile may be used if nonstress tests are nonreassuring