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Trials have shown these 2 drugs to be effective, and no evidence of harm to the fetus has been found, although the potential for long-term adverse effects remains a concern.Various fetal biophysical tests can ensure that the fetus is well oxygenated, including fetal heart rate testing, fetal movement assessment, ultrasonographic biophysical scoring, and fetal umbilical Doppler ultrasonographic studies.However, the rising prevalence of diabetes mellitus—21 million people (7% of the population) have some form of diagnosed diabetes—particularly type 2 among women of childbearing age in the United States, has resulted in increasing numbers of pregnant women with preexisting diabetes.
In Hispanic, black, and Asian populations, the incidence is 5-8%.
The goal of insulin therapy during pregnancy is to achieve glucose profiles similar to those of nondiabetic pregnant women.
In gestational diabetes, early intervention with insulin or an oral agent is key to achieving a good outcome when diet therapy fails to provide adequate glycemic control.
Conversely, Hispanic women have higher rates of macrosomia and birth injury than women of other ethnicities, even with aggressive management.
Infants of mothers with preexisting diabetes experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission.