From the Guidelines
Gestational diabetes should be managed with lifestyle behavior change as the essential component, and insulin should be added if needed to achieve glycemic targets. This approach is based on the most recent guidelines from the Diabetes Care journal, published in 2023 1. The management of gestational diabetes mellitus (GDM) is crucial to prevent complications such as large-for-gestational-age birth weight, neonatal and pregnancy complications, and long-term maternal type 2 diabetes and abnormal glucose metabolism of offspring in childhood.
Key Recommendations
- Lifestyle behavior change, including a balanced diet and regular moderate exercise, is the first line of treatment for GDM 1.
- Insulin is the preferred medication for treating hyperglycemia in GDM, and should be added if lifestyle changes do not adequately control blood sugar levels 1.
- Metformin and glyburide should not be used as first-line agents, as they cross the placenta to the fetus, and other oral and noninsulin injectable glucose-lowering medications lack long-term safety data 1.
- Telehealth visits for pregnant people with GDM can improve outcomes compared with standard in-person care 1.
Importance of Screening and Treatment
GDM is characterized by an increased risk of complications, and all pregnant people should be screened as outlined in the guidelines 1. The risk of GDM may be reduced by diet, exercise, and lifestyle counseling, particularly when interventions are started during the first or early in the second trimester 1. Untreated GDM can lead to reduced insulin sensitivity and β-cell compensation in offspring, and increase the risk of impaired glucose tolerance in childhood 1. Therefore, it is essential to manage GDM effectively to prevent short-term and long-term complications.
From the Research
Definition and Complications of Gestational Diabetes
- Gestational diabetes mellitus (GDM) is a complication that affects pregnant women, increasing the risk of short-term and long-term complications for both mother and offspring, such as birth complications, babies large for gestational age (LGA), and type 2 diabetes 2.
- GDM is associated with adverse health outcomes during pregnancy and beyond, including adverse cardiometabolic outcomes for both mother and infant 3, 4.
Management of Gestational Diabetes
- Lifestyle changes, including diet and physical activity, are essential in the management of GDM 2, 3.
- The diet recommended for women with GDM should contain sufficient macronutrients and micronutrients to support fetal growth, while limiting postprandial glucose excursions and encouraging appropriate maternal gestational weight gain 2.
- Nutritional counseling should focus on the type, amount, and distribution of carbohydrates in the diet, as blood glucose excursions and hyperglycemic episodes depend on carbohydrate intake 2.
- Physical activity has beneficial effects on glucose and insulin levels and can contribute to better glycemic control 2, 3.
Treatment Options for Gestational Diabetes
- Oral metformin has been shown to be as effective as insulin in managing and controlling GDM, with benefits including reduced neonatal birth weight, lower rates of neonatal hypoglycemia and NICU admission, and improved patient compliance 5.
- Insulin therapy is also effective in managing GDM, but may be associated with higher rates of maternal hypoglycemia and lower patient compliance compared to metformin 5.
Prevention of Gestational Diabetes
- Diet and/or physical activity interventions during pregnancy may have a protective effect in preventing GDM, although the results are variable and more studies are needed to establish conclusions about the most efficient type of intervention and dose-effect relationship 6.
- Establishing a healthy diet and engaging in regular physical activity during pregnancy may help reduce the risk of developing GDM, although the evidence is not yet conclusive 6.