Postpartum

Insulin requirements usually decrease after delivery and it is not uncommon for the woman to forego insulin for the first 1-2 days after delivery. Insulin adjustments are necessary to prevent hypoglycemia.

There are no contraindications to lactation for the woman with diabetes, and women should be encouraged to breastfeed. The meal plan is adjusted to include additional snacks to avoid hypoglycemia, which may be more frequent during lactation. Women with type 2 diabetes and choosing to breastfeed are advised to continue insulin therapy for the duration of lactation [35, 50]. Oral antidiabetic agents may resume once breastfeeding is terminated or if the woman chooses to formula feed her infant.

Family planning is an important topic to discuss with the woman with preexisting diabetes. The use of contraceptive agents will depend on whether cardiovascular disease is present [51]. Low-dose combinations of progestin and estrogen or progestin-only oral contraceptive agents are recommended for women with hyperlipidemia. Intrauterine devices and barrier methods do not affect blood glucose levels.

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