Gestational diabetes resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords:

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.

Causes

Life Threatening Causes

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

Common Causes

Common causes of gestational diabetes include[1][2]:

Diagnosis

Shown below is an algorithm summarizing the diagnosis of gestational diabetes according the American College of Obstetricians and Gynecologists guidelines[3][4].

 
 
 
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[3][4][5].

 
 
 
 
 
 
 
Patients with confirmed gestational diabetes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lifestyle and dietary modification along with regular monitoring of blood glucose levels.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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.
 

Do's

Don'ts

References

  1. 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.
  2. 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.
  3. 3.0 3.1 3.2 "ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus". Obstet Gynecol. 131 (2): e49–e64. 2018. doi:10.1097/AOG.0000000000002501. PMID 29370047.
  4. 4.0 4.1 American Diabetes Association (2017). "13. Management of Diabetes in Pregnancy". Diabetes Care. 40 (Suppl 1): S114–S119. doi:10.2337/dc17-S016. PMID 27979900.
  5. "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.
  6. 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.
  7. 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.
  8. 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.


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