Table 1—

Laboratory and special exam components of the initial and subsequent evaluation of pregnant women with preexisting type 1 or type 2 diabetes (in addition to usual prenatal lab tests)

Initial evaluationSubsequent testing
A1CEvery 1–3 months
Fasting lipid profile,* including triglycerides, total, HDL, and LDL cholesterolAs indicated
TSHU and thyroid peroxidase antibodies; consider TSH-receptor antibodies if TSH is suppressed <0.03 μU/mlTo monitor treatment
Hemoglobin, serum ferritin; consider vitamin B12 in type 1 diabetesTo monitor treatment
Consider anti-tTG or anti-EMA plus IgA level in type 1 diabetes to diagnose celiac disease*Repeat to confirm abnormal result or monitor effect of gluten-free diet
ALT/AST; possible liver ultrasoundAs indicated
Random urine for ACR or 24-h urine collection for microalbuminuria and creatinine clearance (measure 24-h total protein excretion if urine is dipstick positive for albumin or protein). Serum creatinine for estimated GFR if preconception; creatinine clearance if pregnantEvery 1–3 months if abnormal
Dilated retinal exam*Every 1–6 months according to risk of progression
Assess risk factors for CHD. Resting ECG* in asymptomatic patients age 35 years or older (note changes of prior silent ischemia, LVH, and QTc). Women with suspect angina, atypical chest pain, significant dyspnea, abnormal ECG, or other reasons to suspect CHD should have cardiology consultation with stress ECG, stress echocardiogram, or another appropriate imaging technique*As indicated
Consider testing* for cardiac autonomic neuropathy (heart rate variability with deep breathing, blood pressure response to standing)As indicated
Consider 2-D or Doppler echocardiogram or tissue Doppler imaging* with indication of diabetic cardiomyopathy or systolic or diastolic heart failureAs indicated
Consider testing* for peripheral arteriosclerotic vascular disease if high risk (carotid ultrasound, ankle/brachial blood pressure)As indicated
  • *

    * May be delayed or omitted if performed before pregnancy. EMA, endomyosial antibody; LVH, left ventricular hypertrophy; QTc, Q-T interval controlled for heart rate; tTG, tissue transglutaminase.