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Inpatient Management of Diabetes During Pregnancy

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Diabetes Management in Hospitalized Patients

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

In the United States, there has been a significant increase in the prevalence of pregnant women with gestational diabetes as well as those with pre-existing type 1 or type 2 diabetes. Optimal antenatal, intrapartum, and postpartum glycemic management is imperative as it can prevent long-term and short-term complications to both the mother and the fetus including, but not limited to, macrosomia, birth trauma, higher chance of c-section, as well as neonatal hypoglycemia. Based on the most recent ADA and ACOG guidelines, we discuss the many facets to good antenatal and intrapartum glycemic management, with particular focus on inpatient management during the intrapartum period. Our management recommendations highlight the strikingly different insulin requirements in the different stages of pregnancy as well as in labor, secondary to dynamic changes in insulin resistance. We cover the different approaches to intrapartum management of patients who are on multiple doses of insulin versus insulin pump. Finally, we review management for potential complications such as diabetic ketoacidosis as well as management for the pronounced steroid hyperglycemia encountered with betamethasone administration for preterm labor. With seamless coordination among the endocrinologist, obstetrician, nursing team, and patient, it is possible to overcome the glycemic challenges of pregnancy.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Rawann Nassar, David W. Lam & Nirali A. Shah

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  1. Rawann Nassar
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  2. David W. Lam
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Correspondence to Nirali A. Shah .

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  1. Division of Endocrinology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA

    Rifka C. Schulman-Rosenbaum

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Nassar, R., Lam, D.W., Shah, N.A. (2023). Inpatient Management of Diabetes During Pregnancy. In: Schulman-Rosenbaum, R.C. (eds) Diabetes Management in Hospitalized Patients. Contemporary Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-44648-1_17

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  • DOI: https://doi.org/10.1007/978-3-031-44648-1_17

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