Gestational Diabetes

Gestational diabetes (GDM) is present in 2-3% of all pregnancies; 15% of pregnant women will require insulin during pregnancy. Diabetes can often be controlled by diet, but up to 60% of patients with GDM will become overtly diabetic 5-10 years postpartum. Thus, patients should be screened at 6 weeks after delivery and yearly thereafter.

Diabetes risk factors

• Obesity*
• Positive family history * [First degree relative]
• History of glucose intolerance *
• History of a macrosomic baby, stillbirth or congenital anomaly
• Hispanic, African American, Native American or Pacific Islands ethnicity
• Advanced maternal age

* Patients with these risk factors should be screened at the first prenatal visit and later at 24-28 weeks.

Pregestational diabetes

Less than 10% of all pregnant women with diabetes have pregestational diabetes. Less than 0.5% of American women with diabetes receive preconception counseling. Their infants are at significant risk for congenital anomalies.

Glycemic control before and during pregnancy may reduce this risk. Prior to conception, patients using oral hypoglycemics should switch to insulin preconception and discontinue ACE inhibitors.

Services provided by the Diabetes in Pregnancy program

• Preconception counseling & management 
• Nutritional counseling with a certified perinatal dietitian
• Certified diabetic educators review risks in pregnancy, glucometer use, injection and insulin administration techniques and exercise counseling
• Perinatal consultation regarding ante-, intra- and/or postpartum care for women with diabetesUltrasound services for fetal morphology and, if needed, fetal echocardiography 
• Support group meetings for patients and their significant others
• Services available range from consultation only, co-management, or assumption of total obstetrical and diabetic care

Screening for gestational diabetes

1° Post-Glucola [50gm] test at
24-28 weeks of pregnancy

Abnormal 1° PG
[ > 140 mg/dl ] *

3° Glucose Tolerance Test [100gm]

Abnormal 3° OGTT if > 2 values
meet or exceed limits below **

Fasting: > 95 mg/dl
1 hour: > 180
2 hour: > 155
3 hour: > 140

If despite diet therapy:
Fasting Blood Sugar > 95 and/or
1-2 hr postprandial BS > 120
will require insulin treatment

* If 1° PG > 190 no need for 3°OGTT ==> 
FBS and 1° postprandial instead
** ADA Clinical practice recommendations & 4th International Workshop on GDM 1998