Management of Gestational Diabetes During Pregnancy
Time Frame | Measures |
|---|---|
Before conception | Women who have had gestational diabetes in previous pregnancies should try to reach or maintain a normal weight and engage in modest exercise. The diet should be low in fat, relatively high in complex carbohydrates, and high in fiber. Fasting plasma glucose and HbA1c levels should be checked. |
Prenatal | Diet and caloric intake are individualized and monitored to prevent weight gain of more than about 6.8–11.3 kg (> 15–25 lb) or, if women are obese, more than about 5–9.1 kg (> 11–20 lb). Moderate exercise after meals is recommended. Antenatal testing with the following should be done from 32 weeks to delivery (or earlier if indicated):
≥ 2 weeks. Amount and type of insulin should be individualized. For women with obesity, short-acting insulin is taken before each meal. For women who are not obese, two thirds of the total dose (60% NPH, 40% regular) is taken in the morning; one third (50% NPH, 50% regular) is taken in the evening. Or, women can take long-acting insulin once or twice a day and insulin aspart immediately before breakfast, lunch, and dinner. |
During labor and delivery | Vaginal delivery at term is possible if women have a well-documented delivery date and good diabetic control. Cesarean delivery should be reserved for obstetric indications or fetal macrosomia (> 4500 g), which increases risk of shoulder dystocia. In women with gestational diabetes that is controlled with diet and exercise only, delivery should occur between 39 and 40 6/7 weeks of gestation. For women with gestational diabetes that is well controlled by medications (A2GDM), delivery is recommended from 39 0/7 weeks to 39 6/7 weeks of gestation. Expert opinion supports earlier delivery for women with poorly controlled gestational diabetes; however, recommendations about timing of delivery lack specific guidance. Decision making may be guided by consultation with a maternal fetal medicine specialist. |
HbA1c = glycosylated hemoglobin; NPH = | |