Gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is carbohydrate intolerance, short of overt diabetes, diagnosed during pregnancy. GDM is associated with adverse pregnancy outcomes, such as fetal macrosomia with its attendant risks of birth injury during vaginal delivery, neonatal hypoglycemia, plethora and hyperbilirubinemia, excess fetal/neonatal fat deposition, childhood obesity, and disordered carbohydrate metabolism. Maternal problems include an increased risk of cesarean delivery and hypertensive disorders of pregnancy. Many of these adverse outcomes can be prevented or ameliorated by efforts to maintain maternal euglycemia.

If goals for glucose control are not met, an antidiabetic medication should be prescribed. The Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) network randomized controlled trials (RCTs) demonstrated that identification and treatment of mild GDM reduces adverse outcomes.

Medication was needed in 8% to 20% of subjects. A higher proportion of patients with GDM require antidiabetic medications when the spectrum is not limited to “mild” GDM.
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This post was written by JSM Innovations LLP ( Healthcare Division)