From the Guidelines
To effectively manage Gestational Diabetes Mellitus (GDM), a comprehensive approach should prioritize lifestyle modifications, including diet and exercise, alongside blood glucose monitoring, with the addition of medication if necessary, as recommended by the most recent guidelines 1.
Key Components of GDM Management
- Lifestyle Modifications: Focus on a balanced, carbohydrate-controlled meal plan with 3 meals and 2-3 snacks daily, emphasizing complex carbohydrates, lean proteins, and healthy fats, as supported by recent nutritional guidelines 1.
- Exercise: Engage in moderate physical activity for 30 minutes daily to improve insulin sensitivity and manage blood glucose levels.
- Blood Glucose Monitoring: Check blood sugar 4 times daily - fasting and 1 hour after each meal, with target ranges of fasting <95 mg/dL and 1-hour postprandial <140 mg/dL.
- Medication (if needed): If lifestyle changes do not achieve target blood glucose levels within 1-2 weeks, consider starting insulin therapy, beginning with long-acting insulin and adding rapid-acting insulin as needed, based on the latest recommendations for insulin use in GDM 1.
- Fetal Monitoring: Regular ultrasounds should be performed to assess fetal growth and well-being.
- Delivery Planning: Aim for vaginal delivery at 39-40 weeks if blood glucose is well-controlled and there are no complications, considering earlier delivery if concerns about fetal macrosomia or other complications arise.
Rationale for Recommendations
The approach outlined above is grounded in the most recent and highest quality evidence, emphasizing the importance of lifestyle modifications as the first line of treatment for GDM, with medication added as necessary to achieve glycemic targets 1. This strategy not only helps manage blood glucose levels but also reduces the risks of complications for both mother and baby, aligning with the priorities of minimizing morbidity, mortality, and improving quality of life. Regular monitoring and timely adjustments in management strategies are crucial for optimal outcomes. Furthermore, the use of telehealth visits has been shown to improve outcomes in pregnant individuals with GDM compared to standard in-person care 1, highlighting the potential for innovative care models to enhance management and outcomes in GDM.
From the Research
Treatment Options for Gestational Diabetes Mellitus (GDM)
The treatment options for GDM can be categorized into two main strategies: lifestyle modifications and pharmacological therapy 2.
- Lifestyle Modifications: This approach includes dietary modifications and physical activity. Dietary modifications aim to achieve glycaemic control by providing adequate calories to the mother and foetus, with a focus on the type, amount, and distribution of carbohydrates in the diet 3, 4. Physical activity has beneficial effects on glucose and insulin levels and can contribute to better glycaemic control 3, 4, 5.
- Pharmacological Therapy: Insulin has been the first choice for the treatment of diabetes during pregnancy 2. Metformin has also been used more commonly in diabetic pregnant women in cases where insulin cannot be prescribed, after its safety has been proven 2. However, a high percentage of women may require additional insulin to maintain expected blood glucose levels 2.
Monitoring and Management
Blood glucose levels, HbA1c levels, and ketonuria are monitored to analyze the efficacy of conservative management 2. Women with diet-controlled GDM can wait for spontaneous labor expectantly in case there are no obstetric indications for birth. However, in women with GDM under insulin therapy or with poor glycemic control, elective induction at term is recommended by authorities 2.
Long-term Considerations
Women who have GDM during pregnancy should be counseled about their increased risks of impaired glucose tolerance, type 2 diabetes mellitus, hypertensive disorders, cardiovascular diseases, and metabolic syndrome 2. Future studies should be conducted to investigate whether initiating lifestyle interventions during the preconception period is more beneficial in preventing GDM, and research targeting pregnancy should be designed with a personalized approach 6.