Online ACOG PublicationsACOG Practice Bulletin No. 201: Pregestational Diabetes Mellitus Author Information This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center. While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. All ACOG committee members and authors have submitted a conflict of interest disclosure statement related to this published product. Any potential conflicts have been considered and managed in accordance with ACOG’s Conflict of Interest Disclosure Policy. The ACOG policies can be found on acog.org. For products jointly developed with other organizations, conflict of interest disclosures by representatives of the other organizations are addressed by those organizations. The American College of Obstetricians and Gynecologists has neither solicited nor accepted any commercial involvement in the development of the content of this published product. Number 201 (Replaces Practice Bulletin Number 60, March 2005) 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. Published online on November 20, 2018. Copyright 2018 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Requests for authorization to make photocopies should be directed to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400. American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920 Pregestational diabetes mellitus. ACOG Practice Bulletin No. 201. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:e228–48. Obstetrics & Gynecology: December 2018 - Volume 132 - Issue 6 - p e228-e248 doi: 10.1097/AOG.0000000000002960 Buy Metrics Abstract 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. © 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.