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Gestational Diabetes

Universal screening start at 24-248 weeks.

Consider screening earlier in all women with BMI >25 and one or more risk factors:

  • Physical inactivity
  • 1st degree relative with DM
  • High-risk ethnicity (AA, Latino, NA, Asian, Pacific Islander)
  • Previous GDM or previous more than equal to 4000g birth
  • Hypertension
  • PCOS
  • Prepregnancy BMI >40

Screening test:

1hr OGTT (50g): serum >130-140 , Positive screening test -->3hr OGTT (100g)

3hr OGTT (100g): Fasting plus 1hr, 2hr, 3hr. 2 or more abnormal values = GDMGDM.png

Management

  • Nutrition advise, diet/exercise and 4x/day blood glucose testing (fasting + 2hr postprandial). Goals for fasting 60-90 ; 2hr post prandial : <120
  • If inadequate control --> oral hypoglycemic (glyburide or metformin), if inadequate with max dose --> insulin
  • Glyburide dosing 1.25mg daily (<200lb) or 2.5mg daily (>200lb). increase by 1.25 to 2.5mg q3-7days until at goal. Max dose 20-30mg
  • Metformin dosing 500mg 1-2xdaily with food. Increase dose by 50mg q3-7days 2/2 GI side effects. Max dose 2500mg
  • Insulin management: with active labor or gluc <70mg/dL start D5NS IVF, check fingerstick glucose qhourly. Usually pregestational DM --> IV insulin drip and titrate
  • NST once or twice weekly starting at 32 weeks for controlled on medication without severe feature
  • NST twice weekly starting at 32 weeks for poorly controlled
  • Delivery 39-40w unless poorly control
  • Consider C-sec for EFW >4500g 
  • GDM resolves with delivery so do post partum 75g glucose (2h OGTT) at 6 weeks post partum to identify nongestational DM for all GDM patients

Pocket Obstetrics and gynecology by K Joeph Hurt 2nd edition

 

 

 

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