4.0.0.0 Mgmt. of Ges­ta­tion­al Di­a­betes Mel­li­tus

4.1.0.0 Rec­om­men­da­tions

Recommendations

14.8 Lifestyle change is an es­sen­tial com­po­nent of man­age­ment of ges­ta­tion­al di­a­betes mel­li­tus and may suffice for the treat­ment of many women. Med­i­ca­tions should be added if need­ed to achieve glycemic tar­gets. A

14.9 In­sulin is the pre­ferred med­i­ca­tion for treat­ing hy­per­glycemia in ges­ta­tion­al di­a­betes mel­li­tus as it does not cross the pla­cen­ta to a mea­sur­able ex­tent. Met­formin and gly­buride should not be used as first-‍line agents, as both cross the pla­cen­ta to the fetus. All oral agents lack long-‍term safe­ty data. A

14.10 Met­formin, when used to treat poly­cys­tic ovary syn­drome and in­duce ovu­la­tion, should be dis­con­tin­ued once preg­nan­cy has been confirmed. A

GDM is char­ac­ter­ized by in­creased risk of macro­so­mia and birth com­pli­ca­tions and an in­creased risk of ma­ter­nal type 2 di­a­betes after preg­nan­cy. The as­so­ci­a­tion of macro­so­mia and birth com­pli­ca­tions with oral glu­cose tol­er­ance test (OGTT) re­sults is con­tin­u­ous with no clear inflec­tion points (24). In other words, risks in­crease with pro­gres­sive hy­per­glycemia. There­fore, all women should be test­ed as out­lined in Sec­tion 2 “Clas­sification and Di­ag­no­sis of Di­a­betes.” Al­though there is some het­ero­gene­ity, many ran­dom­ized con­trolled tri­als (RCTs) sug­gest that the risk of GDM may be re­duced by diet, ex­er­cise, and life-‍style coun­sel­ing, par­tic­u­larly when in­ter­ven­tions are start­ed dur­ing the first or early in the sec­ond trimester (33-35).