This Article  • Full text  • PDF  • CME Course for This Article  • Submit Response to Patient's Crossroads  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Obesity  • Diabetes Mellitus  • Surgical Interventions  • Bariatric Surgery  • Gastrointestinal/ Upper Foregut  • Pregnancy and Breast Feeding  • Ophthalmology  • Diabetic Retinopathy  • Alert me on articles by topic

Donald R. Coustan, MD, Discussant

JAMA. 2008;299(21):2550-2557.

Mrs T is a 40-year-old woman with type 2 diabetes and chronic hypertension who has had a gastric bypass procedure and is planning to conceive. She would like to know whether she can continue using metformin during the pregnancy and also is concerned about the effect of the gastric bypass surgery. This article discusses the management of diabetes prior to and during pregnancy, including appropriate preconception evaluation and the use of insulin and oral antidiabetic agents. The implications of gastric bypass surgery for pregnancy are also outlined. Important aspects include the need to optimize metabolic control prior to conception, to evaluate and treat vascular complications of diabetes prior to conception, and to provide the services of a health care team to gravid women with diabetes. Gastric bypass surgery with subsequent weight loss is likely to ameliorate type 2 diabetes, and special attention must be paid to nutrition when women who have undergone such procedures become pregnant.

Author Affiliation: Dr Coustan is the Chace/Joukowsky Professor and Chairman of Obstetrics and Gynecology at the Warren Alpert Medical School of Brown University and Obstetrician and Gynecologist in Chief at Women and Infants Hospital of Rhode Island, Providence.

RELATED ARTICLE

Pregnancy and Diabetes
Janet M. Torpy, Cassio Lynm, and Richard M. Glass
JAMA. 2008;299(21):2590.
EXTRACT | FULL TEXT