Journal List > J Korean Diabetes > v.16(3) > 1054973

Kim: Obstetrical Management of Gestational Diabetes Mellitus

Abstract

Gestational diabetes mellitus (GDM) is traditionally defined as newly onset or detected carbohydrate intolerance during pregnancy. Unprotected exposure to high glucose levels during pregnancy is related to adverse pregnancy outcomes including fetal demise and intrauterine growth restriction associated with placental insufficiency. The most common complications related to GDM comprise macrosomia, shoulder dystocia, brachial plexus palsy, intrauterine fetal death and preeclampsia, polyhydramnios, preterm delivery, and increased cesarean section rate. Moreover, GDM may increase the chance of GDM recurrence in a subsequent pregnancy, impaired glucose tolerance or type 2 DM, and obesity or impaired glucose tolerance in the offspring. Therefore, proper obstetrical management and glucose control are always challenging and important. The aim of this article is to discern: 1) obstetric complications related to GDM diagnosed after pregnancy, 2) various methods of fetal surveillance, 3) proper timing for delivery and mode of delivery, 4) postpartum management for GDM patients and neonates, and 5) preconceptional counseling prior to a possible subsequent pregnancy.

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Table 1.
Management of patients with gestational diabetes
Diet controlled GDM
Detailed US with echocardiography at 18∼22 weeks gestation
Educate the patient regarding kick count at 28∼32 weeks gestation
US for fetal growth every 4 weeks starting at 28 weeks gestation
Delivery no later than 40 weeks gestation
GDM requiring insulin
Detailed US with echocardiography at 18∼22 weeks gestation
Educate the patient regarding kick count at 26∼28 weeks gestation
US for fetal growth every 4 weeks starting at 28 weeks gestation
Twice weekly NST or BPP at 32 weeks gestation
Delivery no later than 39 weeks gestation Vasculopathy combining GDM
Detailed US with echocardiography at 18∼22 weeks gestation
Educate the patient regarding kick count at 26∼28 weeks gestation
Twice weekly NST or BPP at 28∼32 weeks gestation
US for fetal growth every 4 weeks starting at 26 weeks gestation
Umbilical artery Doppler evaluation on the patients with evidence of IUGR, hypertension, and oligohydramnios
Delivery no later than 38 weeks gestation, but earlier delivery determined on a case-by-case basis
GDM, gestational diabetes mellitus; US, ultrasonography; NST, nonstress test; BBP, biophysical profile; IUGR, intrauterine growth retardation.
Vasculopathy includes the pregnancy induced hypertension. Modified from Graves. Clin Obstet Gynecol 2007;50:1007–13, with original copyright holder's permission [20].
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