Gestational diabetes resident survival guide: Difference between revisions

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==Overview==
==Overview==
This section provides a short and straight to the point overview of the disease or symptom.  The first sentence of the overview must contain the name of the disease.
[[Gestational diabetes]] is a common complication that occurs in [[pregnancy]]. It is defined as the [[glucose]] intolerance that develops during [[gestation]] in patients who were not [[diabetic]] before [[pregnancy]]. <ref name="pmid19118289">{{cite journal| author=American Diabetes Association| title=Diagnosis and classification of diabetes mellitus. | journal=Diabetes Care | year= 2009 | volume= 32 Suppl 1 | issue=  | pages= S62-7 | pmid=19118289 | doi=10.2337/dc09-S062 | pmc=2613584 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19118289  }} </ref>The hormones produced during [[pregnancy]] increase resistance to [[glucose]]. In these patients, the [[glucose]] levels are elevated to [[diabetic]] range. There are several risk factors for [[gestational diabetes]] including [[obesity]], previous history of [[gestational diabetes]], sedentary lifestyle, and significant family history of [[diabetes]]. This section provides a short and to the point overview of the [[gestational diabetes]].


==Causes==
==Causes==
===Life Threatening Causes===
===Life-Threatening Causes===
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
There is no known life-threatening cause for [[gestational diabetes]].
* [[Life threatening cause 1]]
* [[Life threatening cause 2]]
* [[Life threatening cause 3]]


===Common Causes===
===Common Causes===
* [[Common cause 1]]
[[Gestational diabetes]] is caused by the production of [[placental hormones]] such as [[estrogen]], [[cortisol]], [[progesterone]], [[leptin]], [[placental lactogen]], and [[placental growth hormone]] that increase [[insulin resistance]]. This promotes endogenous [[glucose]] production and facilitation of transportation of [[glucose]] through the [[placenta]] to the [[fetus]] due to a mild [[hyperglycemic state]]. This is compensated by the increased [[pancreatic beta-cells]] [[insulin]] production through [[hyperplasia]] and [[hypertrophy]]. Some patients, however, may not have the pancreatic reserve to compensate those hormone's effects, possibly due to previous pancreatic [[injury]].<ref name="pmid30373146">{{cite journal| author=Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH| title=The Pathophysiology of Gestational Diabetes Mellitus. | journal=Int J Mol Sci | year= 2018 | volume= 19 | issue= 11 | pages=  | pmid=30373146 | doi=10.3390/ijms19113342 | pmc=6274679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30373146  }} </ref> Risk factors for such cases include:<ref name="pmid27222008">{{cite journal| author=Snowden JM, Mission JF, Marshall NE, Quigley B, Main E, Gilbert WM | display-authors=etal| title=The Impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects. | journal=Obesity (Silver Spring) | year= 2016 | volume= 24 | issue= 7 | pages= 1590-8 | pmid=27222008 | doi=10.1002/oby.21532 | pmc=4925263 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27222008  }} </ref><ref name="pmid25344768">{{cite journal| author=Bouthoorn SH, Silva LM, Murray SE, Steegers EA, Jaddoe VW, Moll H | display-authors=etal| title=Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study. | journal=Acta Diabetol | year= 2015 | volume= 52 | issue= 3 | pages= 445-52 | pmid=25344768 | doi=10.1007/s00592-014-0668-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25344768  }} </ref>
* [[Common cause 2]]
*Increased [[age]];
* [[Common cause 3]]
*High [[BMI|Body mass index]];
* [[Common cause 4]]
*Low levels of [[physical activity]];
* [[Common cause 5]]
*African American, Hispanic, Asian, and Native American race;
*Excessive [[weight gain]];
*Advanced maternal age;
*Intrauterine environment (low or high birthweight);
*Family or personal history of [[gestational diabetes]];
*[[Insulin resistance]], such as [[polycystic ovarian syndrome]].<ref name="pmid30373146">{{cite journal| author=Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH| title=The Pathophysiology of Gestational Diabetes Mellitus. | journal=Int J Mol Sci | year= 2018 | volume= 19 | issue= 11 | pages=  | pmid=30373146 | doi=10.3390/ijms19113342 | pmc=6274679 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30373146  }} </ref>


==Diagnosis==
==Diagnosis==
Shown below is an algorithm summarizing the diagnosis of [[gestational diabetes]] according the American College of [[Obstetrician]]s and [[Gynecologist]]s guidelines<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047  }} </ref><ref name="pmid27979900">{{cite journal| author=American Diabetes Association| title=13. Management of Diabetes in Pregnancy. | journal=Diabetes Care | year= 2017 | volume= 40 | issue= Suppl 1 | pages= S114-S119 | pmid=27979900 | doi=10.2337/dc17-S016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27979900  }} </ref>.
Shown below is an algorithm summarizing the diagnosis of [[gestational diabetes]] according to the American College of [[Obstetrician]]s and [[Gynecologist]]s guidelines<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047  }} </ref><ref name="pmid27979900">{{cite journal| author=American Diabetes Association| title=13. Management of Diabetes in Pregnancy. | journal=Diabetes Care | year= 2017 | volume= 40 | issue= Suppl 1 | pages= S114-S119 | pmid=27979900 | doi=10.2337/dc17-S016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27979900  }} </ref>.
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | A01 | | | A01= All [[pregnant]] women should be screened for [[Gestational diabetes|GDM]] at 24 weeks or more of [[gestation]] }}
{{familytree | | | | A01 | | | A01= All [[pregnant]] women should be screened for [[Gestational diabetes|GDM]] at 24 weeks or more of [[gestation]] }}
Line 43: Line 45:


==Treatment==
==Treatment==
Shown below is an algorithm summarizing the treatment of [[gestational diabetes]] according to the American [[Diabetes]] Association guidelines.
Shown below is an algorithm summarizing the treatment of [[gestational diabetes]] according to the American [[Diabetes]] Association guidelines<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047  }} </ref><ref name="pmid27979900">{{cite journal| author=American Diabetes Association| title=13. Management of Diabetes in Pregnancy. | journal=Diabetes Care | year= 2017 | volume= 40 | issue= Suppl 1 | pages= S114-S119 | pmid=27979900 | doi=10.2337/dc17-S016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27979900  }} </ref><ref name="pmid25855820">{{cite journal| author=| title=Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS.  Electronic cigarette use among patients with cancer: Characteristics of electronic  cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/  cncr.28811. | journal=Cancer | year= 2015 | volume= 121 | issue= 5 | pages= 800 | pmid=25855820 | doi=10.1002/cncr.29118 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855820  }} </ref>.


{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | A01 |A01= [[Patient]]s with confirmed [[gestational diabetes]] }}  
{{familytree | | | | | | | | A01 |A01= [[Patient]]s with confirmed [[gestational diabetes]] }}  
{{familytree | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | B01 |B01= <div style="float: left; text-align: left; height: 18em; width: 19em; padding:1em;">Lifestyle and dietary modification along with regular monitoring of blood glucose levels.
{{familytree | | | | | | | | B01 |B01= <div style="float: left; text-align: left; height: 24em; width: 19em; padding:1em;">Lifestyle and dietary modification along with regular monitoring of [[blood glucose]] levels.
* Food with low or medium glycemic index along with high intake of fiber, fresh fruits, and vegetables.
* Food with low or medium [[glycemic index]] along with high intake of fiber, fresh fruits, and vegetables.
* An active lifestyle with increased physical activity
* Frequent small meals are recommended. The patient should have three meals with snacks in between twice a day.
* The patient is advised to monitor blood glucose levels 4 to 7 times each day.
* An active lifestyle with increased [[physical activity]]
* Blood glucose level maintained in the normal range }}
* The [[patient]] is advised to monitor [[blood]] [[glucose]] levels 4 to 7 times each day.}}
{{familytree | | | | | | | | |!| | | | }}
{{familytree | | | | | | | | C01 |C01= [[Blood]] [[glucose]] level maintained in the normal range? }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01= |B02= }}
{{familytree | | | D01 | | | | | | | | D02 | | |D01= Yes |D02= No }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01= }}
{{familytree | | | E01 | | | | | | | | |E02| |E01=  <div style="float: left; text-align: left; height: 12em; width: 19em; padding:1em;">No need to initiate [[hypoglycemic]] medications. |E02= Step- up approach with administration of [[hypoglycemic]] drugs.
{{familytree | |,|-|^|.| | | | | | | | |!| }}
* [[Insulin]] is the preferred choice with a starting dose of 0.7-1 unit/kg each day divided in a basal-bolus regimen.
{{familytree | D01 | | D02 | | | | | | D03 |D01= |D02= |D03= }}
* [[Metformin]] and [[glyburide]] can also be used but these [[drug]]s cross the [[placenta]] barrier and their long-term effects on [[neonate]]s are unknown.
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
}}
{{familytree | E01 | | | | | | | E02 | | | E03 |E01= |E02= |E03= }}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
{{familytree/end}}
{{familytree/end}}


==Do's==
==Dos==
* The content in this section is in bullet points.
 
*The goals for [[glycemic]] control in [[gestational diabetes]] are fasting [[plasma]] [[glucose]] level less than 95mg/dl, one hour and two hour post-meal [[glucose]] level less than 140 and 120mg/dl, respectively<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047  }} </ref><ref name="pmid30559235">{{cite journal| author=American Diabetes Association| title=9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019. | journal=Diabetes Care | year= 2019 | volume= 42 | issue= Suppl 1 | pages= S90-S102 | pmid=30559235 | doi=10.2337/dc19-S009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30559235  }} </ref>. The [[insulin]] regimen can be adjusted according to the [[blood]] [[glucose]] level. In women with elevated early morning fasting [[glucose]] level, a single dose of intermediate-acting [[insulin]] should be administered at night. In females with elevated postprandial [[glucose]] levels, rapid-acting [[insulin]] should be administered half an hour before meals.
*A single step 75 gram [[oral glucose tolerance test]] can be used to diagnose [[gestational diabetes]]. The [[gestational diabetes]] is diagnosed when [[blood]] [[glucose]] level is equal or greater than 153 mg/dl <ref name="pmid20190296">{{cite journal| author=International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA | display-authors=etal| title=International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. | journal=Diabetes Care | year= 2010 | volume= 33 | issue= 3 | pages= 676-82 | pmid=20190296 | doi=10.2337/dc09-1848 | pmc=2827530 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20190296  }} </ref>. This cut-off criteria increased the [[prevalence]] of [[diabetes]] among [[pregnant]] women in various subpopulations <ref name="pmid21193625">{{cite journal| author=American Diabetes Association| title=Standards of medical care in diabetes--2011. | journal=Diabetes Care | year= 2011 | volume= 34 Suppl 1 | issue=  | pages= S11-61 | pmid=21193625 | doi=10.2337/dc11-S011 | pmc=3006050 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21193625  }} </ref>.
*An [[antenatal]] [[fetal]] monitoring is recommended in [[gestational diabetes]] [[pregnant]] females starting from 32nd week of [[gestation]]<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047  }} </ref>.
*[[Screening]] tests should be done 4-12 weeks after [[delivery]] in [[gestational diabetes]] to identify if [[patient]]s have impaired fasting [[glucose]], [[diabetes]], and impaired [[glucose]] tolerance. The [[screening]] can be done with a fasting [[plasma]] [[glucose]] level or a 75gram [[oral]] [[glucose tolerance test]]. [[Patient]]s with impaired levels should be referred for medical treatment<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047  }} </ref>.


==Don'ts==
==Don'ts==
* The content in this section is in bullet points.
 
*Different [[clinical trial]]s and [[meta-analysis]] have demonstrated considerable [[efficacy]] of [[metformin]] and [[glyburide]] for the treatment of [[gestational diabetes]]. [[Metformin]] has shown more efficacy for [[glycemic]] controlling compared to [[insulin]] in pregnant females. It does not have immediate adverse effects on [[fetus]] and [[neonate]]s but, its long-term effects on [[neonate]]s are still unclear<ref name="pmid30103263">{{cite journal| author=Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J| title=Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. | journal=Cochrane Database Syst Rev | year= 2018 | volume= 8 | issue=  | pages= CD012327 | pmid=30103263 | doi=10.1002/14651858.CD012327.pub2 | pmc=6513179 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30103263  }} </ref><ref name="pmid27150509">{{cite journal| author=Butalia S, Gutierrez L, Lodha A, Aitken E, Zakariasen A, Donovan L| title=Short- and long-term outcomes of metformin compared with insulin alone in pregnancy: a systematic review and meta-analysis. | journal=Diabet Med | year= 2017 | volume= 34 | issue= 1 | pages= 27-36 | pmid=27150509 | doi=10.1111/dme.13150 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27150509  }} </ref>. Hence [[glyburide]] and [[metformin]] is only prescribed to [[pregnant]] females if they cannot tolerate [[insulin]], it may be a safer option or more adequate due to financial restrictions.


==References==
==References==
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Latest revision as of 15:04, 5 February 2021


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mydah Sajid, MD[2]; José Eduardo Riceto Loyola Junior, M.D.[3]

Synonyms and keywords:

Overview

Gestational diabetes is a common complication that occurs in pregnancy. It is defined as the glucose intolerance that develops during gestation in patients who were not diabetic before pregnancy. [1]The hormones produced during pregnancy increase resistance to glucose. In these patients, the glucose levels are elevated to diabetic range. There are several risk factors for gestational diabetes including obesity, previous history of gestational diabetes, sedentary lifestyle, and significant family history of diabetes. This section provides a short and to the point overview of the gestational diabetes.

Causes

Life-Threatening Causes

There is no known life-threatening cause for gestational diabetes.

Common Causes

Gestational diabetes is caused by the production of placental hormones such as estrogen, cortisol, progesterone, leptin, placental lactogen, and placental growth hormone that increase insulin resistance. This promotes endogenous glucose production and facilitation of transportation of glucose through the placenta to the fetus due to a mild hyperglycemic state. This is compensated by the increased pancreatic beta-cells insulin production through hyperplasia and hypertrophy. Some patients, however, may not have the pancreatic reserve to compensate those hormone's effects, possibly due to previous pancreatic injury.[2] Risk factors for such cases include:[3][4]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of gestational diabetes according to the American College of Obstetricians and Gynecologists guidelines[5][6].

 
 
 
All pregnant women should be screened for GDM at 24 weeks or more of gestation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Two-step screening approach is recommended
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
50g of oral glucose load is administered to the patient followed by measurement of venous blood glucose level after 1 hour
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Blood glucose level equal or higher than 190mg/dl or 10.6mmol/l
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
100g of oral glucose load is administered to the patient followed by measured of venous blood glucose level after 3 hours
 
Second screening test not required
 
 
 
 
 
 
 
 
 
 
 
Blood glucose level equal or more than 145mg/dl or 8mmol/l
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Gestational diabetes mellitus diagnosed when there is an abnormal blood glucose level 2 or more times
 
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of gestational diabetes according to the American Diabetes Association guidelines[5][6][7].

 
 
 
 
 
 
 
Patients with confirmed gestational diabetes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lifestyle and dietary modification along with regular monitoring of blood glucose levels.
  • Food with low or medium glycemic index along with high intake of fiber, fresh fruits, and vegetables.
  • Frequent small meals are recommended. The patient should have three meals with snacks in between twice a day.
  • An active lifestyle with increased physical activity
  • The patient is advised to monitor blood glucose levels 4 to 7 times each day.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Blood glucose level maintained in the normal range?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No need to initiate hypoglycemic medications.
 
 
 
 
 
 
 
 
Step- up approach with administration of hypoglycemic drugs.
  • Insulin is the preferred choice with a starting dose of 0.7-1 unit/kg each day divided in a basal-bolus regimen.
  • Metformin and glyburide can also be used but these drugs cross the placenta barrier and their long-term effects on neonates are unknown.
 

Dos

Don'ts

References

  1. American Diabetes Association (2009). "Diagnosis and classification of diabetes mellitus". Diabetes Care. 32 Suppl 1: S62–7. doi:10.2337/dc09-S062. PMC 2613584. PMID 19118289.
  2. 2.0 2.1 Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH (2018). "The Pathophysiology of Gestational Diabetes Mellitus". Int J Mol Sci. 19 (11). doi:10.3390/ijms19113342. PMC 6274679. PMID 30373146.
  3. Snowden JM, Mission JF, Marshall NE, Quigley B, Main E, Gilbert WM; et al. (2016). "The Impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects". Obesity (Silver Spring). 24 (7): 1590–8. doi:10.1002/oby.21532. PMC 4925263. PMID 27222008.
  4. Bouthoorn SH, Silva LM, Murray SE, Steegers EA, Jaddoe VW, Moll H; et al. (2015). "Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study". Acta Diabetol. 52 (3): 445–52. doi:10.1007/s00592-014-0668-x. PMID 25344768.
  5. 5.0 5.1 5.2 5.3 5.4 "ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus". Obstet Gynecol. 131 (2): e49–e64. 2018. doi:10.1097/AOG.0000000000002501. PMID 29370047.
  6. 6.0 6.1 American Diabetes Association (2017). "13. Management of Diabetes in Pregnancy". Diabetes Care. 40 (Suppl 1): S114–S119. doi:10.2337/dc17-S016. PMID 27979900.
  7. "Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811". Cancer. 121 (5): 800. 2015. doi:10.1002/cncr.29118. PMID 25855820.
  8. American Diabetes Association (2019). "9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019". Diabetes Care. 42 (Suppl 1): S90–S102. doi:10.2337/dc19-S009. PMID 30559235.
  9. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA; et al. (2010). "International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy". Diabetes Care. 33 (3): 676–82. doi:10.2337/dc09-1848. PMC 2827530. PMID 20190296.
  10. American Diabetes Association (2011). "Standards of medical care in diabetes--2011". Diabetes Care. 34 Suppl 1: S11–61. doi:10.2337/dc11-S011. PMC 3006050. PMID 21193625.
  11. Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J (2018). "Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews". Cochrane Database Syst Rev. 8: CD012327. doi:10.1002/14651858.CD012327.pub2. PMC 6513179 Check |pmc= value (help). PMID 30103263.
  12. Butalia S, Gutierrez L, Lodha A, Aitken E, Zakariasen A, Donovan L (2017). "Short- and long-term outcomes of metformin compared with insulin alone in pregnancy: a systematic review and meta-analysis". Diabet Med. 34 (1): 27–36. doi:10.1111/dme.13150. PMID 27150509.


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