From the Guidelines
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy in women who did not have diabetes before becoming pregnant, and its management begins with lifestyle modifications, with insulin as the first-line medication therapy if needed, as recommended by 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 sugar levels. It typically develops in the second or third trimester and affects approximately 2-10% of pregnancies. GDM 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 1.
Management
Management of GDM begins with lifestyle modifications, including:
- A balanced diet low in simple carbohydrates
- Regular physical activity (30 minutes of moderate exercise most days)
- Blood glucose monitoring 4-7 times daily (fasting and 1-2 hours after meals) Target blood glucose levels are typically less than 95 mg/dL fasting and less than 140 mg/dL one hour after meals. If lifestyle changes are insufficient, medication may be necessary, with insulin as the first-line medication therapy during pregnancy, as it does not cross the placenta to a measurable extent 1.
Medication Therapy
Insulin regimens may include long-acting insulin (like insulin detemir or insulin glargine) once or twice daily and rapid-acting insulin (like insulin aspart or insulin lispro) before meals. Oral agents such as metformin or glyburide may be used in some cases, but they should not be used as first-line agents due to the lack of long-term safety data 1.
Importance of Prenatal Visits
Regular prenatal visits are essential to monitor both maternal and fetal health. GDM usually resolves after delivery, but women who have had GDM have a 50% increased risk of developing type 2 diabetes later in life, making postpartum screening and long-term follow-up important 1.
Recent Guidelines
The most recent guidelines recommend that lifestyle behavior change is an essential component of management of GDM and may suffice as treatment for many individuals, with insulin added if needed to achieve glycemic targets 1. Telehealth visits for pregnant people with GDM have also been shown to improve outcomes compared with standard in-person care 1.
Key Points
- GDM is a type of diabetes that develops during pregnancy
- Management begins with lifestyle modifications
- Insulin is the first-line medication therapy if needed
- Regular prenatal visits are essential to monitor maternal and fetal health
- Women who have had GDM have a 50% increased risk of developing type 2 diabetes later in life, making postpartum screening and long-term follow-up important 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, 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.
- The prevalence of GDM is rising and correlates with the increase in maternal obesity over recent decades 3.
Management and Treatment 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.
- First-trimester screening can identify preexisting diabetes and early-onset GDM for prompt implementation of glucose control measures 2, 4.
- Fetal surveillance is suggested starting at 32 weeks of gestation for patients with poor glucose control or who require medications 2.
Complications and Risks Associated with GDM
- Fetal macrosomia, defined as a birth weight ≥ 4,000 g, is a common adverse infant outcome of GDM if unrecognized and untreated in time 5.
- GDM complicated by preeclampsia further increases perinatal adverse events with greater impact on the future maternal and offspring health 6.
- 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 5.