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