Gestational diabetes (GDM) is one of the most common complications during pregnancy, occurring in 3 to 15% of all pregnancies. Some risk factors involved in developing GDM include age, family history of diabetes, ethnicity, inactive lifestyle, and obesity. Once GDM is diagnosed, the most common treatment is diet and exercise to decrease the chance of poor outcomes for both the mother and fetus.
For women with GDM, we recommend replacing refined carbohydrates with complex carbohydrates, with carbohydrates making up about 50% of daily caloric intake. Generally at Maternal Fetal Medicine, we suggest women meet with a nutritionist to review a comprehensive eating plan, including foods to avoid and foods to eat more freely.
More physical activity is shown to decrease the risk of GDM, as well as achieving normal blood glucose than with just diet alone. It is encouraged for women to partake in aerobic exercise or increase activity for women with GDM.
Patients with GDM should try to achieve fasting glucoses less than 90 mg/dl, one hour postprandial values less than 140 mg/dl, and two hour values less than 120 mg/dl. If diet and exercise do not achieve the suggested glucose levels, medical therapy may be recommended, such as oral medications or insulin therapy.
Antepartum Fetal Monitoring
We recommend increased fetal testing for women with GDM, including serial ultrasounds to assess fetal growth and health.
Macrosomia, or a large fetus (there are varying definitions) is more common in pregnancies with GDM. A large fetal weight is associated with complications, such as prolonged labor, oxytocin requirement, cesarean delivery, shoulder dystocia, postpartum hemorrhage, and increased rate of lacerations. Cesarean delivery is sometimes recommended if the estimated weight of the fetus is large.
In most cases, women have a rapid resolution of diabetes after delivery, with approximately 15% remaining glucose intolerant or demonstrating overt diabetes after delivery. Women with GDM are 30-70% more likely to develop GDM in future pregnancies, and 10-30% develop diabetes within 5-10 years. Given this information, women with GDM should be screened during the postpartum period, and be screened every few years thereafter.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!