From the Guidelines
The treatment for gestational diabetes should prioritize lifestyle modifications, with insulin as the preferred medication when necessary, to maintain normal blood glucose levels and minimize risks to both mother and fetus. This approach is supported by the most recent and highest quality study, which emphasizes the importance of lifestyle behavior change as an essential component of management of gestational diabetes mellitus (GDM) and may suffice for the treatment of many women 1.
Key Components of Treatment
- Lifestyle modifications, including dietary changes and regular physical activity, are the first line of treatment for gestational diabetes.
- Insulin is the preferred medication for treating hyperglycemia in GDM, due to its ability to effectively manage blood glucose levels without crossing the placenta to the fetus 1.
- Metformin and glyburide should not be used as first-line agents, as they cross the placenta to the fetus and lack long-term safety data 1.
- Regular prenatal visits are essential to monitor both maternal glucose levels and fetal development.
Importance of Treatment
- Uncontrolled gestational diabetes can lead to complications such as macrosomia (large baby), increased risk of cesarean delivery, and neonatal hypoglycemia.
- Women with gestational diabetes should be screened for type 2 diabetes 4-12 weeks postpartum and regularly thereafter, as they have an increased lifetime risk of developing diabetes.
- Telehealth visits for pregnant people with GDM have been shown to improve outcomes compared with standard in-person care, including reduced incidences of cesarean delivery, neonatal hypoglycemia, and other complications 1.
Recent Guidelines
The most recent guidelines from 2023 support the use of lifestyle modifications and insulin as the primary treatment for gestational diabetes, with a focus on achieving glycemic targets to minimize risks to both mother and fetus 1. These guidelines also emphasize the importance of regular prenatal visits and screening for type 2 diabetes after delivery.
Conclusion Not Applicable
Instead, the focus is on providing a clear and concise answer to the question, prioritizing the most recent and highest quality evidence. In this case, the evidence supports the use of lifestyle modifications and insulin as the primary treatment for gestational diabetes, with a focus on achieving glycemic targets and minimizing risks to both mother and fetus.
From the FDA Drug Label
Available information from published randomized controlled trials with insulin aspart products use during the second trimester of pregnancy have not reported an association with insulin aspart products and major birth defects or adverse maternal or fetal outcomes Poorly controlled diabetes in pregnancy increases the maternal risk for diabetic ketoacidosis, preeclampsia, spontaneous abortions, preterm delivery, and delivery complications Poorly controlled diabetes increases the fetal risk for major birth defects, stillbirth, and macrosomia related morbidity
The treatment for gestational diabetes involves controlling blood sugar levels to prevent complications. Insulin aspart can be used during the second trimester of pregnancy, as it has not been associated with major birth defects or adverse maternal or fetal outcomes 2. However, it is crucial to maintain good glycemic control to minimize the risks associated with poorly controlled diabetes in pregnancy, such as:
- Diabetic ketoacidosis
- Preeclampsia
- Spontaneous abortions
- Preterm delivery
- Delivery complications
- Major birth defects
- Stillbirth
- Macrosomia related morbidity
From the Research
Treatment of Gestational Diabetes
The treatment of gestational diabetes involves lifestyle modifications, including diet and physical activity, with the addition of insulin or metformin if glycaemic control remains inadequate 3.
- Dietary Changes: The diet recommended for women with gestational diabetes should contain sufficient macronutrients and micronutrients to support the growth of the fetus and limit postprandial glucose excursions and encourage appropriate maternal gestational weight gain 4.
- Physical Activity: Physical activity has beneficial effects on glucose and insulin levels and can contribute to better glycaemic control 4, 5.
- Medical Nutrition Therapy: Medical nutrition therapy (MNT) is an essential component of gestational diabetes management, focusing on achieving optimal glycaemic control through careful macronutrient balance, particularly the distribution and quality of carbohydrate intake, and sufficient protein and fat intake 3.
Lifestyle Interventions
Lifestyle interventions, including healthy eating and physical activity, have been shown to reduce the risk of gestational diabetes mellitus (GDM) 6, 7.
- Healthy Eating: An antenatal healthy eating intervention is associated with less gestational weight gain and lower fasting glucose compared with physical activity alone 6.
- Physical Activity: Supporting women to increase physical activity and achieve appropriate weight gain during early pregnancy has the potential to reduce rates of GDM 7.
Management of Gestational Diabetes
Effective management of gestational diabetes involves lifestyle modifications, with the addition of insulin or metformin if glycaemic control remains inadequate 3.