Obstetrical Management of Gestational Diabetes Mellitus

Moon Young Kim

doi:10.4093/jkd.2015.16.3.182

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Kim: Obstetrical Management of Gestational Diabetes Mellitus

Focused Issue

J Korean Diabetes 2015;16(3):182-188.

Published online: 10 January 2015

DOI: https://doi.org/10.4093/jkd.2015.16.3.182

Obstetrical Management of Gestational Diabetes Mellitus

Moon Young Kim

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Korea

Corresponding author: Moon Young Kim Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University Medical School, 17, Seoae-ro 1-gil, Jung-gu, Seoul 04619, Korea, E-mail: mykimdr@gmail.com

Received 3 August 2015 Accepted 17 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Gestational diabetes, Obstetrics, Preconception, Pregnancy complication

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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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