Accepted
at 12:15 a.m. Mar, 17, 2025
by
mmatheso
Author:
jlee47
Type of change:
Updated content
Rationale for change
ACOG shows <180 for under 1 hour
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Gestational diabetes mellitus (GDM) has become increasingly prevalent due to the obesity epidemic. Women with GDM are at increased risk for gestational hypertension, preeclampsia, fetal macrosomia, and cesarean delivery. Although GDM resolves after childbirth, up to half of women will develop type 2 DM later in life. All pregnant women should be screened for GDM at 24-28 weeks gestation. Patients with risk factors (eg, obesity, previous GDM, previous macrosomic infant) should be screened early in pregnancy and then rescreened at 24-28 weeks gestation if the initial screen is negative.
Failure to achieve glycemic control with nutritional therapy warrants pharmacotherapy initiation. Insulin does not cross the placenta and has long been an accepted therapy for GDM that is unresponsive to dietary modifications and exercise. Oral medications (eg, glyburide, metformin) are equivalent in efficacy and are widely used as first-line pharmacotherapy.
Initial treatment includes dietary modifications composed of evenly distributed carbohydrate, protein, and fat intake over 3 meals and 2-4 snacks daily. Glucose levels should be monitored throughout the day with fasting and either 1-hour or 2-hour postprandial blood glucose levels. Fasting blood glucose levels should be <95 mg/dL. A 1-hour level of <140 mg/dL or a 2-hour level of <120 mg/dL is an acceptable goal.
Failure to achieve glycemic control with nutritional therapy warrants pharmacotherapy initiation. Insulin does not cross the placenta and has long been an accepted therapy for GDM that is unresponsive to dietary modifications and exercise. Oral medications (eg, glyburide, metformin) are equivalent in efficacy and are widely used as first-line pharmacotherapy.
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