Gestational Diabetes

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Presentation :

• Develops in the second and third trimesters
  • If identified in the first trimester, it is more likely pre-existing undiagnosed DM2 rather than GDM

Pathophysiology :

Diagnostic Testing:

• A comprehensive eye examination should be completed once per trimester.

Treatment :

• Insulin is the recommended therapy, metformin typically used if pts can't/won't use insulin
• Although metformin (2nd line) or sulfonylurea therapy may be considered, both therapies cross the placenta, and no long-term safety data are available for their use during pregnancy.
  • Additionally, sulfonylurea therapy has been associated with higher rates of neonatal macrosomia and hypoglycemia.
• Glycemic targets in pregnancy include premeal plasma glucose <95 mg/dL, 1-hour postprandial values <140 mg/dL, and 2-hour postprandial values <120 mg/dL.
• ACE inhibitors, ARBs, and cholesterol-lowering drugs should be stopped before pregnancy.

Prognosis:

References: