Pregestational diabetes mellitus represents one of the most challenging medical complications of pregnancy because of the need for frequent monitoring and adjustment of medications as well as the potential for maternal and fetal complications.

This document provides an overview of the current understanding of pregestational diabetes mellitus and suggests management guidelines during pregnancy. Because few well-designed studies have been performed, many of the guidelines are based on expert and consensus opinion. This document has been updated to reflect current data on pregestational diabetes.

This Practice Bulletin is updated with summary information to counsel and manage women with pregestational diabetes before and during pregnancy, more recent literature reflecting experience with continuous subcutaneous insulin infusion during pregnancy, an expanded section on the role of oral hypoglycemic agents in pregnancy, and the option of long-acting reversible contraception during the postpartum period.

Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics with the assistance of Aaron B. Caughey, MD, PhD; Anjali J. Kaimal, MD, MAS; and Steven G. Gabbe, MD The Journal of Obstetrics & Gynecology
ACOG Practice Bulletin No. 201
Obstetrics & Gynecology: December 2018 — Volume 132 — Issue 6 — p e228-e248