What prenatal care advice should be given to women diagnosed with Gestational Diabetes Mellitus (GDM)?

From the Guidelines

Women diagnosed with gestational diabetes should follow a comprehensive prenatal care plan that includes regular blood glucose monitoring, dietary modifications, exercise, and possibly medication, with the goal of achieving optimal blood glucose levels to prevent complications and ensure the best possible outcomes for both mother and baby. This plan should be individualized and based on the latest evidence, which emphasizes the importance of lifestyle behavior change as an essential component of management of gestational diabetes mellitus 1.

Key Components of Prenatal Care

• Regular blood glucose monitoring: checking blood glucose levels 4-7 times daily (fasting and after meals), aiming for fasting levels below 95 mg/dL and one-hour postprandial levels below 140 mg/dL
• Dietary modifications: focusing on consistent carbohydrate intake (about 175g daily), distributed across three moderate meals and 2-3 snacks, emphasizing complex carbohydrates, protein, and healthy fats while limiting simple sugars 1
• Exercise: moderate exercise for 30 minutes daily, such as walking after meals, helps control blood glucose
• Medication: if lifestyle changes are insufficient, insulin therapy may be prescribed, with common regimens including long-acting insulin (like insulin glargine 10-20 units at bedtime) and/or rapid-acting insulin (like insulin aspart 2-6 units before meals) 1

Additional Recommendations

• Women should attend more frequent prenatal visits (every 1-2 weeks) to monitor fetal growth and adjust the treatment plan as needed
• Additional ultrasounds should be performed to monitor fetal growth and detect any potential complications early
• Women should prepare for possible labor induction at 39-40 weeks to prevent complications like macrosomia and birth injuries
• Lifestyle modifications after pregnancy, such as reducing weight and increasing physical activity, are recommended to reduce the risk of subsequent diabetes 1

By following this comprehensive prenatal care plan, women with gestational diabetes can reduce their risk of complications and ensure the best possible outcomes for both themselves and their babies.

From the Research

Prenatal Care Advice for Women with Gestational Diabetes

Prenatal care advice for women diagnosed with gestational diabetes should include:

• Dietary advice: Women with gestational diabetes should receive individually tailored dietary advice to manage their condition effectively 2.
• Self-monitoring of blood glucose: Women should be trained to self-monitor their blood glucose levels to ensure they are within the target range 2.
• Medication: Metformin can be recommended as an effective substitute for insulin in the treatment of gestational diabetes, with similar glycemic control and neonatal outcomes 3, 4, 5.
• Collaboration between healthcare professionals: Care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes should be improved to avoid women feeling like they need to coordinate their own care 2.

Key Considerations

• Women with gestational diabetes should meet healthcare professionals with sufficient knowledge about the condition as soon as possible after diagnosis 2.
• The combination of metformin and insulin aspart may be an effective treatment approach for gestational diabetes, reducing blood glucose levels, mitigating renal injury, and improving pregnancy outcomes 6.
• Treatment with metformin may be more effective in controlling maternal and fetal hypoglycemia and neonatal birth weight compared to insulin injection 5.

Maternal and Fetal Outcomes

• Maternal and fetal outcomes, such as birth weight, Apgar score, and neonatal hypoglycemia, were similar between metformin and insulin treatment groups in some studies 3, 4, 5.
• However, other studies found that metformin was beneficial in reducing neonatal birth weight and neonatal hypoglycemia 5.
• The incidence of adverse pregnancy outcomes in both newborns and mothers was lower in women treated with the combination of metformin and insulin aspart compared to insulin aspart alone 6.