Gestational diabetes and water intake -
Complications of gestational diabetes can include:. Large babies born to individuals with gestational diabetes can be at increased risk of developing diabetes and obesity during their lifetime. See "Patient education: Preeclampsia Beyond the Basics ".
Furthermore, those with gestational diabetes are at high risk of developing pre-diabetes impaired glucose tolerance or type 2 diabetes when they are no longer pregnant, so they need to be tested for diabetes postpartum and in the years after giving birth. More detailed information about gestational diabetes is available by subscription.
See "Gestational diabetes mellitus: Screening, diagnosis, and prevention" and "Gestational diabetes mellitus: Glucose management and maternal prognosis". Timing of test — Testing for gestational diabetes is usually done once between 24 and 28 weeks of pregnancy.
However, testing for diabetes may be done as early as your first prenatal visit if you have risk factors for diabetes, such as:. Test procedure — There are a few ways to test for gestational diabetes.
Two-part test — On the day of the screening test, you can eat and drink normally. You will be given 50 grams of glucose, usually in the form of a specially formulated orange or cola drink.
You should drink the entire amount within a few minutes. One hour later, you will have a blood test to measure your blood sugar level. If your screening test blood sugar level is high but not very high, you will need another test to know for sure if you have gestational diabetes.
This test is called an oral glucose tolerance test GTT. The test is done by measuring your blood sugar level before you eat or drink anything in the morning fasting , then again one, two, and three hours after you drink a glucose drink that contains grams of glucose twice the amount in the one-hour test.
Similar to the one-hour test, this is usually in the form of a specially formulated orange, lemon-lime, or cola drink. Gestational diabetes is diagnosed if you have two or more elevated blood sugar values during the GTT, although some doctors may recommend treatment after a single elevated value, especially if you have other signs of gestational diabetes a big fetus or extra fluid around your fetus.
One-part test — Some doctors and nurses test for diabetes with a one-part test. The test is done by measuring your blood sugar level before you eat or drink anything in the morning fasting , then again one and two hours after you drink a glucose drink that contains 75 grams of glucose.
This is usually in the form of a specially formulated orange, lemon-lime, or cola drink. Gestational diabetes is diagnosed if you have one or more elevated blood sugar values. After you are diagnosed with gestational diabetes, you will need to make changes in what you eat and learn to check your blood sugar level.
You may also be advised to get more exercise. See "Gestational diabetes mellitus: Glucose management and maternal prognosis". The main goal of treatment for gestational diabetes is to reduce the risk of complications such as those mentioned above.
One of the main complications is an overly large baby weighing more than 9 to 10 lbs at birth. You are more likely to have a large baby if your blood sugar levels are higher than normal during the pregnancy. A large baby can be difficult to deliver vaginally. The baby can get stuck after the head is born called "shoulder dystocia".
This increases the risk of injury to the baby eg, broken bones or nerve injury and to the mother eg, more severe vaginal tears. If labor does not progress normally, you may need a cesarean birth. Eating plan — The first treatment for gestational diabetes is eating right. To help you achieve the changes you should make in your diet, you will meet with a dietitian, nurse, or certified diabetic educator a nurse or dietician that specializes in diabetes.
The general guidelines below will help you until you receive your individualized food plan:. This includes candy, cake, cookies, ice cream, donuts, jams and jellies, syrups, and sweet sauces.
Also avoid adding sugar to your food or drinks, sweetened soda, punch, sweet tea, and other fruity beverages. Moderation is suggested. These sweeteners have not been linked to an increased risk of congenital anomalies birth defects. Other protein foods like cheese, eggs, nuts, seeds, and peanut butter are also good for you and your baby.
Avoid fruit juice or limit percent fruit juice to one-half cup 4 ounces per serving. Many dieticians recommend avoiding fruits for breakfast because of concerns about higher blood sugar levels in the early morning. Choose low-fat yogurt that is plain, "light," or Greek style.
Include plenty of salads, greens spinach, collards, kale , broccoli, carrots, green beans, tomatoes, onions, mushrooms, and other vegetables you enjoy. Half of the plate at your meals can be non-starchy vegetables. Blood sugar monitoring — You will learn how to check your blood sugar level and record the results figure 1.
Instructions for choosing a blood sugar meter, checking blood sugar levels at home, and ways to record the results are discussed separately. See "Patient education: Glucose monitoring in diabetes Beyond the Basics ".
This information can help to determine whether your blood sugar levels are on target. If your levels stay higher than they should be, your doctor will probably recommend that you start using insulin. See 'Insulin' below. Exercise — Although exercise is not a necessary part of gestational diabetes treatment, it might help to control blood sugar levels.
If you were exercising before, you should continue after being diagnosed with gestational diabetes. If you did not previously exercise, ask your doctor or nurse if exercise is recommended. Most individuals who do not have medical or pregnancy-related complications are able to exercise, at least moderately, throughout their pregnancy.
Walking is a great form of exercise for those starting an exercise regimen. Insulin — Approximately 15 percent of patients with gestational diabetes will require insulin.
Insulin is a medicine that helps to reduce blood sugar levels and can reduce the risk of gestational diabetes-related complications. Insulin is the most common medicine for treating gestational diabetes.
You must give insulin by injection because it does not work when it is taken by mouth. Most pregnant people start by giving one to two shots of insulin per day.
If your blood sugar levels are high after eating, you may need to give yourself a shot three or four times per day. Instructions for drawing up and giving insulin shots are available separately.
See "Patient education: Type 2 diabetes: Insulin treatment Beyond the Basics ". If you take insulin, you should check your blood sugar level at least four times per day. You also need to write down your results or store them in the meter and how much insulin you took and review these records at each prenatal visit or more frequently based on your doctor's recommendation figure 1.
Keeping accurate records helps to adjust insulin doses and can decrease the risk of complications. The bedtime snack is especially important to help keep your fasting first blood sugar of the day before eating in range. Oral diabetes medicines, such as those taken by people with type 2 diabetes, are sometimes used during pregnancy in the United States.
We prefer insulin therapy for pregnant patients with diabetes who cannot control blood glucose levels adequately by their diet nutritional therapy. Insulin is effective and safe and does not cross the placenta to the fetus.
Most oral diabetes medicines pass from the pregnant individual to their baby through the placenta; while they have not been shown to harm the fetus or newborn, it is not known if there are longer term effects on children.
There are studies underway to help answer this question. However, oral anti-hyperglycemic agents are a reasonable alternative for individuals who will not take, or are unable to comply with, insulin therapy, as long as they understand the lack of information on long-term risks or benefits. Prenatal visits — Most pregnant individuals who develop gestational diabetes have more frequent prenatal visits eg, once every week or two , especially if insulin is used.
The purpose of these visits is to monitor your and your baby's health, discuss your diet, review your blood sugars, and adjust your dose of insulin if you are taking it to keep your blood sugar levels near normal. It is common to change the dose of insulin as the pregnancy progresses.
You may also be asked to have one or two ultrasound examinations to check on the growth and size of the baby. See "Gestational diabetes mellitus: Obstetric issues and management". Nonstress testing — You may need tests to monitor the health of the baby during the later stages of pregnancy, especially if your blood sugars have been high, you are using insulin, or if you have any pregnancy-related complications eg, high blood pressure.
The most commonly used test is the nonstress test. This test is discussed in a separate topic review. See "Patient education: Postterm pregnancy Beyond the Basics ". If your blood sugar levels are close to normal during pregnancy and you have no other complications, the ideal time to give birth is between 39 and 40 weeks of pregnancy, no later than your due date.
If you do not give birth by your due date, you may be offered induction of labor or additional testing to monitor your and your baby's health. In most individuals with gestational diabetes and a normal-size baby, there are no advantages to a cesarean over a vaginal birth, although cesarean may be needed in any pregnancy, especially with a first baby.
Those with a very large baby may be offered cesarean birth before labor starts. The risks and benefits of cesarean birth are discussed separately.
See "Patient education: C-section cesarean delivery Beyond the Basics ". Your blood sugar levels will be monitored during labor. Most individuals have normal blood sugar levels during labor and do not need any insulin. Insulin is given if your blood sugar level becomes high.
High blood sugar levels during labor can cause problems in the baby, both before and after delivery. See "Pregestational preexisting and gestational diabetes: Intrapartum and postpartum glucose management".
After giving birth, most individuals with gestational diabetes have normal blood sugar levels and do not require further treatment with insulin.
You can return to your prepregnancy diet, and you are encouraged to breastfeed. See "Patient education: Deciding to breastfeed Beyond the Basics ". However, your doctor may check your blood sugar level the day after delivery to be sure that it is normal or near normal.
Pregnancy itself does not increase the risk of developing type 2 diabetes. However, having gestational diabetes does increase your risk of developing type 2 diabetes later in life. After you deliver, you should have testing for type 2 diabetes. Typically, this is done between 4 and 12 weeks postpartum, ideally prior to your postpartum check-up.
Meta-analyses comparing use of oral antihyperglycemic agents with insulin therapy have generally found that both approaches can improve some pregnancy outcomes in patients with GDM or type 2 diabetes [ 61, ]. There is a trend toward more frequent maternal hypoglycemia with use of insulin [ 71 ], and some patients on oral agents need supplemental insulin to achieve and maintain glucose levels in the target range [ 74 ].
However, it is difficult to draw firm conclusions about the optimal approach because of inconsistencies in criteria for GDM, glucose targets, patient adherence to treatment, clinical outcome measures across studies, and lack of long-term safety data [ 71 ].
In randomized trials, compared with insulin, metformin :. In randomized trials, compared with insulin, glyburide :.
Dose — The insulin dose required to achieve target glucose levels varies among individuals, but the majority of studies have reported a total dose ranging from 0. Dose titration to blood glucose levels is based upon frequent self-monitoring. At least four daily glucose measurements are required fasting and one or two hours postprandial with the addition of pre-lunch and pre-dinner measurements as needed to optimize therapy and ensure timely dose increases as insulin requirements increase with pregnancy progression.
The insulin requirement in twin gestations complicated by GDM may double with pregnancy progression. We do not use insulin pumps in patients with GDM because there are no data to suggest that they are necessary or more effective than conventional therapy, and the cost of an insulin pump is not justified over the relatively short duration of a pregnancy.
However, case reports have described successful use in some pregnant people. Pragmatic approach to management of hyperglycemia — Hospitalization is not necessary to initiate insulin therapy; however, if teaching some patients the procedures they need to know is not possible in the outpatient setting, then an inpatient stay to utilize the expertise of the hospital's nursing staff may justify the cost of hospitalization.
One principle we have found useful is to start with the simplest regimen and increase the complexity as needed to address the particular situation. Typically, regardless of body weight, insulin dosing is based on the glucose levels recorded in the patient's blood glucose log.
Because any insulin regimen requires serial dosing adjustments in response to specific fasting or postprandial glucose levels, the starting dose should be considered just that, a starting point. Weekly glucose log review is recommended so that insulin doses can be adjusted as needed to meet target glucose levels as the pregnancy advances.
Some patients may be diagnosed with diabetes and therapy initiated early in pregnancy prior to 24 to 28 weeks screening ; these patients are managed differently and generally require slightly lower insulin doses since insulin resistance is lower early in pregnancy.
We prefer NPH due to the peak at four to six hours after the dose, which may also aid in covering postprandial lunch excursions. Levemir can also be used but is peakless and would not help as much with the lunch post-meal peak.
The upper end of this range is not likely to lead to hypoglycemia in patients with both obesity and GDM unless a meal is omitted after insulin is given. If both post-breakfast and post-lunch glucose levels are elevated, increasing the morning NPH may be sufficient.
The initial dose is 0. Dosing based on glucose levels and weight — An alternative approach to insulin therapy, somewhat more complex and likely most appropriate for individuals whose glucose levels are not well managed with simpler paradigms, is described below:.
A long-acting insulin analog insulin glargine or detemir may be used instead [ 77 ]. See "General principles of insulin therapy in diabetes mellitus". The starting dose is calculated by trimester of pregnancy and body weight: 0.
In patients with class II or III obesity, the initial doses of insulin may need to be increased to 1. Two-thirds of the total daily dose is administered in the morning, with two-thirds of the morning dose given as basal insulin and one-third given as rapid-acting insulin up to 15 minutes before breakfast.
One-third of the total daily dose is administered in the evening, with half of this dose given as rapid-acting insulin up to 15 minutes before dinner and the other half given as basal insulin as a nighttime dose usually at bedtime but before dinner is another option on an individualized basis.
A lunchtime dose of rapid-acting insulin may be added if there is continued postprandial lunch hyperglycemia. Hypoglycemia remote from meal or snack time is rare in patients with GDM treated with pharmacotherapy, and it is treated by administering 10 to 20 g of a fast-acting carbohydrate snack immediately.
Since the sugars in milk release more slowly into the bloodstream than pure sugar options, the glucose pattern seen with pure sugars ie, rapid elevation of glucose followed by a rapid decline may be dampened.
See "Hypoglycemia in adults with diabetes mellitus", section on 'Reversing hypoglycemia'. Patients who are feeling better may recheck their blood glucose 15 to 30 minutes after treatment. On the other hand, they may need to give themselves extra insulin to compensate for overtreatment of the symptoms.
If low glucose values are encountered more than once at the same time of day, insulin doses are adjusted downward accordingly. Type of insulin — Use of insulin preparations of low antigenicity may minimize transplacental transfer of insulin antibodies.
Human insulin is the least immunogenic of the commercially available preparations. The three rapid-acting insulin analogs lispro, aspart, glulisine are comparable in immunogenicity to human regular insulin , but only lispro and aspart have been investigated in pregnancy and shown to have acceptable safety profiles, minimal transfer across the placenta, and no evidence of teratogenesis.
Neonatal outcomes are similar to those of patients treated with regular insulin [ 61 ]. These two insulin analogs both improve postprandial excursions compared with human regular insulin and are associated with lower risk of delayed postprandial hypoglycemia.
Long-acting insulin analogs insulin glargine , insulin detemir have not been studied as extensively in pregnancy, but data from patients with preexisting pregestational diabetes and studies of placental transfer suggest that both detemir and glargine are safe and effective for use in pregnancy [ ].
See "Pregestational preexisting diabetes mellitus: Antenatal glycemic control", section on 'Type of insulin'. Based on available data, we prefer using human NPH insulin as part of a multiple injection regimen in pregnant people with GDM, especially given the peak at four to six hours after the morning dose, which can help decrease lunch postprandial blood glucose levels without an additional dose of rapid-acting insulin [ 86 ].
The body of data support the safety and effectiveness of NPH in pregnancy, and doses can be adjusted frequently and quickly in response to changing requirements in pregnant patients. If a longer-acting insulin analog is used, we prefer detemir insulin because it can be dosed twice a day, similar to NPH, with the advantage over NPH of more consistent absorption and less variability in absorption among patients.
Insulin detemir is preferred over insulin glargine because it has been studied more extensively in pregnancy and can be dosed twice per day more predictably than glargine, as previously mentioned. See "General principles of insulin therapy in diabetes mellitus", section on 'Safety'.
Oral hypoglycemic agents — Metformin and glyburide are the only noninsulin antihyperglycemic drugs used in pregnancy. Both oral hypoglycemic agents offer the advantage of significantly decreased cost compared with insulin.
Metformin is not associated with hypoglycemia. Choosing metformin versus glyburide — Clinically important pregnancy outcomes are generally similar for metformin and glyburide , with only limited evidence of benefit of one oral agent over the other.
Fetal metformin levels are percent of the maternal level and glyburide levels are 70 percent of the maternal level, which has unknown long-term consequences [ ]. Although metformin and glyburide have not been associated with an increased risk of congenital anatomic anomalies, when either drug is prescribed, patients should be made aware that information regarding the long-term effects of transplacental passage, including possible fetal programming effects, are largely unknown, so caution is warranted until more data are available [ ].
Metformin — A typical dosing regimen is to start metformin extended release XR mg orally once daily with dinner and, if tolerated, increase by mg eg, mg with dinner or mg with dinner plus mg with breakfast based on the degree of glucose elevations. The dose can then be increased by to mg orally per week until reaching the usual effective dose of to mg orally per day divided into two doses maximum daily dose is mg [ 98 ].
An immediate release preparation is also available, but we prefer the XR as it may cause fewer gastrointestinal side effects and fewer daily doses may be needed. The most common side effects of metformin are gastrointestinal, including a metallic taste in the mouth, mild anorexia, nausea, abdominal discomfort, and soft bowel movements or diarrhea.
These symptoms are usually mild, transient, and reversible after dose reduction or discontinuation of the drug. Symptoms can be mitigated by starting at a low dose with slow-dose escalation as needed.
In a clinical trial, only 2 percent of study subjects discontinued metformin because of gastrointestinal side effects [ 98 ]. The ADA recommends avoiding metformin in patients with hypertension, preeclampsia, or at risk for intrauterine growth restriction due to the potential for growth restriction or acidosis in the setting of placental insufficiency [ 24,92 ]; however, any clinical impact of this effect has not been observed in human pregnancies.
The American College of Obstetricians and Gynecologists ACOG and the Society for Maternal-Fetal Medicine do not include this caveat in their recommendations.
Glyburide — Starting doses of 2. Twice-daily dosing is often necessary to maintain glucose levels in the target range. One group that investigated glyburide pharmacokinetics in pregnancy suggested pregnant patients take the drug 30 to 60 minutes before a meal, rather than with the meal, to improve efficacy [ 99 ].
In this study, plasma glyburide concentrations in pregnant patients with GDM did not increase until one hour after drug ingestion, peaked at two to three hours, and returned to baseline by 8 to 10 hours. Thus, the drug took longer to reach peak concentration and was metabolized more rapidly than in nonpregnant females.
Maternal hypoglycemia is the most common side effect, and the risk was higher than that in patients with GDM using insulin in a large trial Patients who fail to achieve glycemic control with oral pharmacotherapy — If oral pharmacotherapy alone does not adequately manage glucose levels, supplemental insulin can be prescribed and may be easier for the patient than switching to a multidose insulin only regimen.
In contrast to nonpregnant patients, dual use of oral agents eg, metformin plus glyburide is not recommended in pregnancy because of minimal safety and efficacy data [ 88 ] and concerns about adverse fetal effects since both drugs cross the placenta.
See "Pregestational preexisting and gestational diabetes: Intrapartum and postpartum glucose management". See "Gestational diabetes mellitus: Obstetric issues and management". MATERNAL PROGNOSIS — Most patients with GDM are normoglycemic after giving birth.
However, they are at high risk for recurrent GDM and developing prediabetes impaired glucose tolerance or impaired fasting glucose or overt diabetes over the subsequent five years.
Optimum interpregnancy care to minimize these risks has not been well-studied in randomized trials [ ]. Feasibility trials of a web-based lifestyle intervention and a telephone-based intervention reported less postpartum weight retention in patients with GDM assigned to the intervention, suggesting this type of behavioral intervention may have a favorable impact [ , ].
Recurrence — GDM in one pregnancy is a strong predictor of recurrence in a subsequent pregnancy [ ]. In a study including over 65, pregnancies, the frequency of GDM in the second pregnancy among patients with and without previous GDM was 41 and 4 percent, respectively [ ].
Risk factors for recurrence include high birth weight in the index pregnancy, older maternal age, high parity, high prepregnancy weight, and high weight between pregnancies [ , ].
Long-term risk — A history of GDM is predictive of an increased risk of developing type 2 diabetes, metabolic syndrome, cardiovascular disease CVD , and even type 1 diabetes.
These risks appear to be particularly high in patients with both GDM and a hypertensive disorder of pregnancy [ ]. GDM has been called a "marker," "stress test," or "window" for future diabetes and CVD; it is not considered causal. The RR was 17 within the first five years after delivery and approximately 10 after that.
The lifetime maternal risk for diabetes has been estimated to be as high as 50 to 60 percent [ , ]. Waist circumference and body mass index BMI are the strongest anthropometric measures associated with development of type 2 diabetes in patients with GDM [ 61, ], as they are in those without GDM.
Other major risk factors are gestational requirement for insulin and early gestational age at the time of diagnosis ie, less than 24 weeks of gestation [ ]. Additional risk factors for impaired glucose tolerance and overt diabetes later in life include autoantibodies eg, glutamic acid decarboxylase, insulinoma antigen-2 , high-fasting blood glucose concentrations during pregnancy and early postpartum, higher-fasting plasma glucose at diagnosis of GDM and high glucose levels in the GTT, the number of abnormal values on the glucose tolerance test, neonatal hypoglycemia, and GDM in more than one pregnancy [ 61,,,, ].
In one study, an additional pregnancy increased the rate ratio of type 2 diabetes threefold compared with individuals without an additional pregnancy RR 3.
The authors hypothesized that repeated episodes of insulin resistance contribute to the decline in beta-cell function that leads to type 2 diabetes in many high-risk individuals.
Parity, large birth weight, and diabetes in a first-degree relative are less correlated with later diabetes. Specific human leukocyte antigen HLA alleles DR3 or DR4 may predispose to the development of type 1 diabetes postpartum, as does the presence of islet-cell autoantibodies [ ] or antibodies against glutamic acid decarboxylase or insulinoma antigen 2.
GDM in lean pregnant people, need for insulin treatment of GDM, diabetic ketoacidosis during pregnancy, and postpartum hyperglycemia also suggest preexisting unrecognized type 1 diabetes or high risk of developing type 1 diabetes [ ]. Although testing for antibodies is not routinely recommended, it is important for clinicians to be aware of this association.
Distinguishing type 1 from type 2 diabetes, and monogenic forms of diabetes eg, maturity-onset diabetes of the young [MODY] from type 1 and type 2 diabetes, is reviewed in detail elsewhere. See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Differentiating the cause' and "Classification of diabetes mellitus and genetic diabetic syndromes".
In one study of patients with mild GDM ie, normal fasting glucose level on glucose tolerance test [GTT] , approximately one-third developed metabolic syndrome within 5 to 10 years after giving birth [ ]. Even mild glucose impairment defined as an abnormal 50 g one-hour GTT followed by a normal g three-hour GTT appears to identify individuals at increased risk of future development of CVD, usually myocardial infarction or stroke [ ].
In these studies, the increased risk was related to development of type 2 diabetes later in life. More recent data demonstrate that the increased risk of CVD in patients with a prior history of GDM may be independent of the development of type 2 diabetes. Meta-regression analysis showed that the rates of incident type 2 diabetes across the studies did not affect this risk and when individuals with type 2 diabetes were excluded, GDM was still associated with an increased risk of future CVD RR 1.
The increased mortality risk was primarily due to CVD 0. Testing — Long-term follow-up for development of type 2 diabetes is routinely recommended for individuals with GDM, given their high risk for developing the disorder [ 24,43 ].
GTT — A common approach is to order a GTT to be performed 4 to 12 weeks after giving birth, using the 75 g GTT, as recommended by the American Diabetes Association ADA [ 24 ]. Criteria for diagnosis of diabetes and prediabetes are shown in the tables table 2A-B.
Suboptimal adherence has been attributed to not ordering the test, lack of patient follow-up for postpartum care, patient burden associated with a fasting and a two-hour laboratory procedure, and patient difficulty with childcare [ ].
There is increasing evidence that performing the test while the patient is still hospitalized after birth increases adherence to nearly percent and provides reliable results [ , ]. At one year postpartum, the A1C was consistent with impaired glucose metabolism in 35 percent and diabetes in 4 percent of individuals tested.
Fasting glucose — A fasting plasma glucose level is a reasonable alternative to the GTT but does not allow for diagnosis of impaired glucose tolerance.
A glycated hemoglobin A1C can be performed in patients in whom obtaining a fasting specimen is especially inconvenient but performs less well for diagnosis of diabetes or prediabetes in postpartum patients because of increased peripartum red cell turnover [ ].
See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Diagnostic tests'. They should have yearly assessment of glycemic status. Approaches to prevention of type 2 diabetes are reviewed in detail separately.
See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Prediabetes' and "Prevention of type 2 diabetes mellitus".
Higher intensity and longer duration of breastfeeding during the first two years postpartum is associated with a reduced risk of developing type 2 diabetes in observational studies. See "Gestational diabetes mellitus: Obstetric issues and management", section on 'Breastfeeding'.
They should also be given advice regarding contraception and the planning of future pregnancies, especially the importance of good glycemic management prior to conception. See "Overview of general medical care in nonpregnant adults with diabetes mellitus" and "Pregestational preexisting diabetes: Preconception counseling, evaluation, and management".
See 'Recurrence' above and 'Long-term risk' above. Lifestyle interventions are beneficial for reducing the incidence of type 2 diabetes in persons with prediabetes [ ] and these interventions diet and exercise, achieving a normal body mass index, avoiding smoking and excessive alcohol intake also appear to be beneficial in patients with a history of GDM, whether or not they meet criteria for prediabetes [ ].
The annual incidence of diabetes may be reduced by 30 to 50 percent or more compared with no intervention [ , ]. Pharmacotherapy eg, metformin , pioglitazone may also have a role in preventing future type 2 diabetes. In a multicenter randomized trial, both intensive lifestyle and metformin therapy reduced the incidence of future diabetes by approximately 50 percent compared with placebo in patients with a history of GDM; metformin was much more effective than lifestyle intervention in parous patients with previous GDM [ ].
This topic is discussed in detail separately. See "Prevention of type 2 diabetes mellitus". Reassessment of glycemic status should be undertaken at a minimum of every three years eg, every one to three years [ 24 ]. More frequent assessment may be important in patients who may become pregnant again, since early detection of diabetes is important to preconception and early prenatal care.
More frequent screening every one or two years may also be indicated in patients with other risk factors for diabetes, such as family history of diabetes, obesity, and need for pharmacotherapy during pregnancy.
The best means of follow-up testing has not been defined. The two-hour 75 g oral GTT is the more sensitive test for diagnosis of diabetes and impaired glucose tolerance in most populations, but the fasting plasma glucose is more convenient, specific, and reproducible, and less expensive.
A1C is convenient and the preferred test for patients who have not fasted overnight. See "Screening for type 2 diabetes mellitus", section on 'Screening tests'.
See "Overview of primary prevention of cardiovascular disease". Follow-up of patients not screened for GDM — For patients who did not undergo screening for GDM, but diabetes is suspected postpartum because of newborn outcome eg, hypoglycemia, macrosomia, congenital anomalies , a postpartum GTT may be considered.
A normal postpartum GTT excludes the presence of type 1 or type 2 diabetes or prediabetes; it does not exclude the possibility of GDM during pregnancy and the future risks associated with this diagnosis.
Indications for screening and tests used for screening are discussed separately. See "Screening for type 2 diabetes mellitus". SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately.
See "Society guideline links: Diabetes mellitus in pregnancy". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.
These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest.
We suggest glucose self-monitoring before breakfast and at one or at two hours after the beginning of each meal. See 'Glucose monitoring' above.
See 'Can the frequency of self-monitoring be reduced? Moderate exercise also improves glycemic control and should be part of the treatment plan for patients with no medical or obstetric contraindications to this level of physical activity.
See 'Rationale for treatment' above and 'Exercise' above. Calories are generally divided over three meals and two to four snacks per day and are composed of approximately 40 percent carbohydrate, 20 percent protein, and 40 percent fat.
Gestational weight gain recommendations are shown in the table table 1. See 'Medical nutritional therapy' above. Pharmacotherapy can reduce the occurrence of macrosomia and large for gestational age in newborns.
See 'Indications for pharmacotherapy' above. We start with the simplest insulin regimen likely to be effective based on the glucose levels recorded in the patient's blood glucose log and increase the complexity as needed.
An alternative approach based on both patient weight and glucose levels is somewhat more complex and likely most appropriate for individuals whose glucose levels are not well managed with simpler paradigms. See 'Insulin' above. The long-term effects of transplacental passage of noninsulin antihyperglycemic agents are not known.
See 'Oral hypoglycemic agents' above. Testing can be performed while the patient is still in the hospital after giving birth.
Otherwise it is performed 4 to 12 weeks postpartum and, if results are normal, at least every three years thereafter. See 'Maternal prognosis' above.
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View Topic. Font Size Small Normal Large. Gestational diabetes mellitus: Glucose management and maternal prognosis. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Author: Celeste Durnwald, MD Section Editors: David M Nathan, MD Erika F Werner, MD, MS Deputy Editor: Vanessa A Barss, MD, FACOG Contributor Disclosures.
All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Nov 16, There were no significant maternal or neonatal harms from treatment of GDM. Insulin Dose — The insulin dose required to achieve target glucose levels varies among individuals, but the majority of studies have reported a total dose ranging from 0.
Follow-up Testing — Long-term follow-up for development of type 2 diabetes is routinely recommended for individuals with GDM, given their high risk for developing the disorder [ 24,43 ]. Electronic address: pubs smfm. SMFM Statement: Pharmacological treatment of gestational diabetes.
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Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med ; HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al.
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BJOG ; Landon MB, Rice MM, Varner MW, et al. Mild gestational diabetes mellitus and long-term child health. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association.
Diabetes Care ; 31 Suppl 1:S Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. Hernandez TL, Brand-Miller JC. Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Yamamoto JM, Kellett JE, Balsells M, et al.
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Back watrr Gestational diabetes. If you have inttake diabetes, wxter chances of having problems Altitude training adaptations the pregnancy can be reduced by controlling your blood An glucose levels. You'll diabstes need to be more closely wxter during pregnancy and labour to check if treatment is Glutamine and endurance and for any problems. You'll be given a testing kit that you can use to check your blood sugar glucose level. This involves using a finger-pricking device and putting a drop of blood on a testing strip. If you take insulin and have problems with low blood sugar hypoglycaemia or your blood sugar is not stable, your care team might offer you a continuous glucose monitor CGM. This is a small sensor you wear on your skin that sends data wirelessly to a receiver or a mobile phone, so you can see your blood sugar level at any time. Imtake 28, Cedars-Sinai Staff. Calorie intake for teenagers other types of diabetes, gestational diabetes usually goes Gestationak soon after Altitude training adaptations. Gestational Gestatioal is when a woman without diabetes develops high blood Diabbetes levels during pregnancy. During pregnancy, higher levels of other hormones can interfere with your body's sensitivity to insulin, resulting in elevated blood sugar. Unlike other types of diabetes, gestational diabetes usually goes away on its own and soon after delivery blood sugar levels return to normal, says Dr. Tania Esakoffclinical director of the Prenatal Diagnosis Center.
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