From the Guidelines
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy in women who didn't have diabetes before becoming pregnant, and it is typically managed through a combination of lifestyle modifications and medication when necessary, with insulin being the preferred medication during pregnancy, as stated in the most recent guidelines 1.
Definition and Significance
GDM occurs when the body cannot produce enough insulin to meet the extra needs during pregnancy, resulting in high blood glucose levels. It is characterized by an increased risk of large-for-gestational-age birth weight and neonatal and pregnancy complications, as well as an increased risk of long-term maternal type 2 diabetes and abnormal glucose metabolism in offspring in childhood, as noted in a recent study 1.
Management
The first-line approach involves dietary changes, focusing on controlled carbohydrate intake distributed throughout the day, along with regular physical activity of 30 minutes most days as tolerated. Blood glucose monitoring is essential, with target levels being below 95 mg/dL fasting and below 140 mg/dL one hour after meals.
- Lifestyle modifications, including diet and exercise, are the initial treatment for GDM, and may suffice for the treatment of many individuals, as recommended in the latest guidelines 1.
- If lifestyle changes don't adequately control blood glucose levels after 1-2 weeks, medication is typically added, with insulin being the preferred medication during pregnancy, due to its safety profile and effectiveness, as highlighted in a recent review 1.
- Oral agents such as metformin or glyburide may be used in some cases, but their use is not recommended as first-line agents due to the lack of long-term safety data, as stated in the most recent guidelines 1.
Importance of Management
GDM requires careful management because it increases risks of complications for both mother and baby, including preeclampsia, cesarean delivery, macrosomia, birth injuries, and neonatal hypoglycemia. Most women with GDM return to normal blood glucose levels after delivery, but they have an increased risk of developing type 2 diabetes later in life, making postpartum follow-up important, as emphasized in a recent study 1.
Recent Guidelines
Recent guidelines, including those from 2024 1 and 2023 1, emphasize the importance of lifestyle modifications and insulin therapy in the management of GDM, and provide recommendations for the diagnosis, treatment, and management of GDM, with the goal of reducing the risks of complications and improving outcomes for both mother and baby. In summary, the management of GDM should prioritize lifestyle modifications and insulin therapy, with careful monitoring and follow-up to reduce the risks of complications and improve outcomes, as recommended in the most recent guidelines 1.
From the Research
Definition and Significance of Gestational Diabetes Mellitus (GDM)
- Gestational diabetes mellitus (GDM) is a common condition of pregnancy characterized by high blood sugar levels that are first recognized during pregnancy 2.
- GDM increases the risks of complications, including operative delivery, hypertensive disorders, shoulder dystocia, fetal macrosomia, large-for-gestational-age infants, neonatal hypoglycemia, and neonatal respiratory distress 2.
Management of GDM
- Treatment of GDM has been shown to reduce the risk of complications and should start with lifestyle modifications, such as diet and exercise 2.
- For patients who are unable to maintain euglycemia with lifestyle modifications alone, insulin is the recommended first-line medication 2.
- Dietary interventions, such as the Dietary Approaches to Stop Hypertension (DASH) diet and the low-glycemic index (Low-GI) diet, have been shown to be effective in managing GDM and reducing adverse pregnancy outcomes 3.
Complications and Risks Associated with GDM
- GDM is associated with an increased risk of fetal macrosomia, which can lead to complications such as shoulder dystocia, clavicle fractures, and brachial plexus injury 4.
- Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age and are more likely to develop type II diabetes later in life 4.
- GDM is also associated with an increased risk of preeclampsia, which can further increase perinatal adverse events and have a greater impact on future maternal and offspring health 5.