What is the management plan for women with diet-controlled gestational diabetes?

From the Guidelines

The management plan for women with diet-controlled gestational diabetes should focus on regular monitoring and lifestyle modifications without medication, with the goal of minimizing maternal hyperglycemia and its associated complications. Women should check their blood glucose levels four times daily: fasting (target <95 mg/dL) and 1-hour postprandial after each meal (target <140 mg/dL) 1. Dietary recommendations include consuming 2,000-2,500 calories daily distributed across three meals and 2-3 snacks, with carbohydrates limited to 40-45% of total calories. Regular moderate exercise for 30 minutes daily is recommended. Patients should attend weekly or biweekly prenatal visits for weight and blood pressure monitoring, with fetal surveillance including growth ultrasounds every 3-4 weeks starting at 28-32 weeks. For well-controlled cases, delivery can be planned at 39-40 weeks, though induction at 38-39 weeks may be considered if there are additional risk factors. If glucose targets are consistently not met despite dietary adherence, medication (typically insulin) should be initiated, as insulin is the preferred medication for treating hyperglycemia in gestational diabetes mellitus 1.

Some key points to consider in the management plan include:

• Lifestyle behavior change is an essential component of management of gestational diabetes mellitus and may suffice as treatment for many individuals 1
• Telehealth visits for pregnant people with gestational diabetes mellitus improve outcomes compared with standard in-person care 1
• The risk of gestational diabetes may be reduced by diet, exercise, and lifestyle counseling, particularly when interventions are started during the first or early in the second trimester 1
• Metformin and glyburide should not be used as first-line agents, as both cross the placenta to the fetus 1
• Breastfeeding is recommended for infants of women with gestational diabetes, and successful lactation requires planning and coordination of care 1

Overall, the management plan should prioritize minimizing maternal hyperglycemia and its associated complications, while also promoting a healthy lifestyle and pregnancy outcomes.

From the Research

Management Plan for Women with Diet-Controlled Gestational Diabetes

The management plan for women with diet-controlled gestational diabetes involves a combination of lifestyle modifications and medical interventions. The primary goal is to maintain blood glucose levels within a target range to prevent complications for both the mother and the fetus.

• Lifestyle Modifications: Medical nutrition therapy is the cornerstone of therapy for women with gestational diabetes mellitus (GDM) 2. This includes a healthy diet and regular physical activity to help manage blood glucose levels.
• Blood Glucose Monitoring: Daily self-monitoring of blood glucose has been found to help guide management in a much better way than blood glucose checking in labs and clinics 2.
• Fetal Surveillance: Fetal surveillance is suggested starting at 32 weeks of gestation for patients with poor glucose control or who require medications 3.
• Insulin Therapy: Insulin is the recommended first-line medication for patients who are unable to maintain euglycemia with lifestyle modifications alone 3.
• Oral Hypoglycemic Agents: Oral hypoglycemic agents, such as glyburide and metformin, have been found to be safe, effective, and economical for the treatment of gestational diabetes 2, 4.
• Fetal Ultrasound: Fetal ultrasound can be used to identify women with mild GDM whose infants are at high risk for fetal macrosomia and to guide metabolic therapy 5.
• Delivery Planning: The recommended delivery range for patients controlling their glucose levels with lifestyle modifications alone is 39/0 to 40/6 weeks of gestation, and the ideal range for those controlling glucose levels with medications is 39/0 to 39/6 weeks of gestation 3.

Key Considerations

• Women with GDM have an increased risk of developing overt diabetes, and continued lifestyle modifications, breastfeeding, and use of metformin can reduce this risk 3.
• The use of insulin or metformin has a similar impact on markers of metabolic syndrome in women with GDM requiring antidiabetic treatment 4.
• Fetal ultrasound early in the third trimester can identify women with mild GDM whose infants are at high risk for fetal macrosomia, and insulin treatment can reduce this risk 5.