Second trimester

1. After the first two prenatal visits, which are scheduled one week apart, women are seen every two to four weeks through the second trimester, or more frequently if glycemic control is suboptimal.

2. Maternal analyte screening. A triple or quadruple maternal serum screen should be offered to help detect neural tube defects and Down syndrome (ie, triple screen = alpha-fetoprotein + unconjugated estriol + human chorionic gonadotropin; inhibin A is added for a quadruple screen).

3. Ultrasound examination at eighteen weeks of gestation is routine in pregestational diabetes. The ultrasound examination should include a fetal survey with a four-chamber view of the heart and visualization of the outflow tracts.

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