-Gestational diabetes mellitus develops during pregnancy in women whose pancreatic function is insufficient to overcome the insulin resistance associated with the pregnant state.
-Identifying pregnant women with gestational diabetes mellitus followed by appropriate therapy can decrease fetal and maternal morbidity, particularly macrosomia, shoulder dystocia, and preeclampsia.
Two-step screening test: Screen everyone at 24 to 28 weeks; The first step is a 50-gram one-hour glucose challenge test (GCT). Positive patients go on to the second step, a 100-gram, three-hour oral glucose tolerance test (GTT), which is the diagnostic test for gestational diabetes mellitus.
-Adverse outcomes associated with gestational diabetes: Preeclampsia, gestational hypertension, hydramnios, macrosomia, maternal and infant birth trauma, operative delivery (cesarean, instrumental), perinatal mortality, Fetal/neonatal hypertrophic cardiomyopathy, neonatal respiratory problems and metabolic complications (hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia)
-Long-term, women with gestational diabetes mellitus are at increased risk of developing type 2 diabetes as well as type 1 diabetes and cardiovascular disease.
-A diagnosis of overt diabetes is made when A1C is ≥6.5 percent.
-Nutritional therapy, Glucose monitoring, target fasting blood glucose <95 mg/dl; insulin, selected oral antihyperglycemic agents (metformin, glyburide)
A single third trimester ultrasound to screen for macrosomia.
Scheduled cesarean delivery to avoid birth trauma is typically offered to women with GDM and estimated fetal weight ≥4500 grams.
-All women with GDM should have a two-hour, 75-gram oral glucose tolerance test between 6 and 12 weeks postpartum