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Gestational Diabetes Management Guidelines

The document discusses gestational diabetes mellitus (GDM), highlighting the increased risks for congenital malformations and complications in infants born to diabetic women. It outlines screening recommendations based on ADA guidelines, including testing for diabetes before and during pregnancy, and provides diagnostic criteria for GDM using both one-step and two-step strategies. Management strategies include lifestyle changes, pharmacologic treatments, and glycemic targets to ensure maternal and fetal health.

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7 views8 pages

Gestational Diabetes Management Guidelines

The document discusses gestational diabetes mellitus (GDM), highlighting the increased risks for congenital malformations and complications in infants born to diabetic women. It outlines screening recommendations based on ADA guidelines, including testing for diabetes before and during pregnancy, and provides diagnostic criteria for GDM using both one-step and two-step strategies. Management strategies include lifestyle changes, pharmacologic treatments, and glycemic targets to ensure maternal and fetal health.

Uploaded by

vsggkhyvmn
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Gestational Diabetes

Mellitus

Yashkumar Majithiya, 02/12/25


Diabetes and Pregnancy

Congenital CNS malformation in infants born to diabetic women which can range
from anencephaly or encephalocele. Caudal or sacral agenesis is very specific to
diabetes.

• The risk increases up to 2-4 fold in diabetic women compared to women without
diabetes.

It occurs 200 times more frequently in women with uncontrolled diabetes when
compared to the general population.

Macrosomia and Shoulder dystocia is also common

Nephron underdosing at birth is a big risk factor. (DM,HTN,PTM)


GDM
Recommendations based on ADA Guidelines
In individuals planning for pregnancy, screen those with risk factors and consider
testing all individuals of childbearing potential for undiagnosed pre diabetes or
diabetes

Before 15 weeks of gestation, test individuals for undiagnosed diabetes at the first
prenatal visit using standard diagnostic criteria if not screened before. Screen for early
abnormal glucose metabolism with dysglycemia using FPG of 110-125 mg/dl or A1c
5.9% - 6.4% .

Screen for GDM at 24-28 weeks of gestation in pregnant individuals not previously
found to have diabetes or high-risk abnormal glucose metabolism detected earlier in
the current pregnancy.

Screen individuals with GDM for prediabetes or diabetes at 4-12 weeks postpartum,
using the 75 grams OGTT and clinically appropriate non pregnancy diagnostic criteria.

Individuals with a history of GDM should have lifelong screening for the development
of prediabetes or diabetes at least every 3 years.
Screening and diagnosis
One step strategy

75g OGTT with fasting (min 8 hours) at 24-28 weeks. The diagnosis is made when
any of the following values are met or exceeded

Fasting : 92 mg/dl

1 h : 180 mg/dl

2h : 153 mg/dl
TWO Step Strategy

Step 1 - Perform a 50g GT non fasting, with measurements at 1h, at 24-28 weeks
of gestations in individuals not previously diagnosed with diabetes. If the load is
>130mg/dl, proceed to step 2.

Step 2 : 100g OGTT with fasting. Diagnosis of GDM is made when at least two of
the following values are met or exceeded.

Fasting - 95 mg/dl

1h - 180 mg/dl

2h - 155 mg/dl

3h - 140 mg/dl
Management

Non pharmacologic trial for 2 weeks - Lifestyle changes. If glycemic goals are met,
continue to monitor every 2 weeks ( follow up intervals may reduce towards the
end of pregnancy). Follow up postpartum.

If the glycemic goals are not met - Initiate pharmacologic Rx. Insulin is Drug of
choice in pregnancy

If patient is non-adherent to insulin or excessive weight gain - Metformin is second


line drug. It may cross placenta

Third line - glyburide . Least preferred. Linked to increased neonatal


hypoglycaemia, macrosomia, increased abdominal circumference in newborns and
insufficient long term safety data for children exposed to glyburide during
gestation.
Glycemic targets
Based on 5th Int. Workshop Conference on GDM
Fasting - <95 mg/dl

1 hr post prandial - <140 mg/dl

2 hr Post prandial - <120 mg/dl

A1C - <6.5

For women with pre-existing diabetes , following are recommended goals if


they can be achieved without hypoglycaemia.

1. Fasting - 60 to 99 mg/dl

2. Peak Postprandial - 100-130 mg/dl

3. A1c < 6.0 %


Thank You

References - ADA guidelines

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