Gestational DM

Gestational diabetes

Glucose intolerance that begins or is first recognized during pregnancy

  • ↑ risk of:

    • Macrosomia: Birth weight >90th percentile OR >4-4.5kg (8lb 13oz–9lb 15oz) ➔ shoulder dystocia, birth injury, childhood obesity

    • Polyhydramnios, preeclampsia, cesarean delivery

    • Hyperbilirubinemia, hypoglycemia

    • Respiratory distress syndrome

    • Mom has ↑ risk for developing overt diabetes postpartum

      • 2-hour (75 g) glucose tolerance test at 6-weeks postpartum

Glucose Challenge (Screening) 24-28 weeks

  • NOT FASTING - 50g of oral glucose with plasma glucose at 1 hour

    • ≥ 135 mg/dL (abnormal) ➔ OGTT

    • ≥ 200 mg/dL = GDM (OGTT not needed)

Oral Glucose Tolerance Test

  • FASTING - 100 g glucose loading, q1h, 2h, 3h

    • ≥ 95 mg/dL fasting

    • Or at least 2 abnormals after loading:

      • 1hr: ≥ 180 mg/dL

      • 2hr: ≥ 155 mg/dL

      • 3hr: ≥ 140 mg/dL

TX:

  • Dietary counseling and home BG monitoring (4x/day) for 1wk

    • Metformin 500mg if 30% of weekly BG results are:

      • > 95 mg/dL when fasting

      • > 140 mg/dL (1hr post-prandial)

      • > 120 mg/dL (2hr post-prandial)

      • Or ↑ fetal ABD circumference/estimated fetal weight

    • Insulin if not normoglycemic with metformin