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Gestational diabetes is a carbohydrate intolerance of variable severity that starts or is first recognized during pregnancy or the inability of the tissues to absorb glucose from the bloodstream during pregnancy due to a lack of the hormone insulin. Glucose is a form of sugar that is present in many foods, including sweets, potatoes, pasta, and breads. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Pregnant women without known diabetes mellitus should be screened for GDM after 24 weeks of gestation. Increased secretion of placental hormones leads to increasing insulin resistance, especially throughout the third trimester. Antenatal testing in women who have GDM that is well controlled without medications is not beneficial,40 because the risk of stillbirth is not increased in this population.41 Antenatal testing is commonly performed in women who require medication for GDM, although data supporting this practice are limited to older observational studies. Clinicians should prepare to manage shoulder dystocia at the time of delivery and exercise caution when considering an operative vaginal delivery.Women with GDM rarely need oral agents or insulin immediately after delivery. Treatment of GDM results in a statistically significant decrease in the incidence of preeclampsia, shoulder dystocia, and macrosomia. Preventive Services Task Force updated its 2008 statement to recommend that asymptomatic pregnant women be screened for GDM after 24 weeks of gestation (B recommendation). Although women with elevated glucose levels on the 75-g test have an increased risk of adverse pregnancy outcomes,17 no trials have demonstrated that treatment of GDM in these women improves outcomes.


The pancreas produces a hormone (a chemical produced in one part of the body, which travels to another part of the body in order to exert its effect) called insulin.
Most clinicians in the United States use a two-step approach, first administering a 50-g non-fasting oral glucose challenge test at 24 to 28 weeks, followed by a 100-g fasting test for women who have a positive screening result.13A  Alternatively, clinicians may use a one-step approach and administer only a 75-g two-hour fasting oral glucose tolerance test. Some physicians obtain serial ultrasonography (separated by at least four weeks) to monitor fetal growth in patients with GDM. Insulin is required to allow glucose to enter the liver, muscles, and fatty tissues, thus reducing the amount of glucose in the blood.
If glucose levels remain above target values, pharmacologic therapy with metformin, glyburide, or insulin should begin. Less intensive glucose monitoring is appropriate for women with GDM that is well controlled with diet and exercise.1,2LIFESTYLE CHANGESInitial treatment for GDM involves diet and activity modification. Women with GDM should receive individualized nutrition counseling from a registered dietitian, which commonly includes a recommendation to limit carbohydrate intake to 33% to 40% of calories.2 No high-quality data exist on the optimal diet for women with GDM.
Induction of labor should not occur before 39 weeks in women with GDM, unless glycemic control is poor or another indication for delivery is present. This search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Unless otherwise indicated, scheduled cesarean delivery should be considered only in women with an estimated fetal weight greater than 4,500 g.


Maternal obesity, excess gestational weight gain, and GDM are independent and additive risk factors for macrosomia.
Also searched were the Agency for Healthcare Research and Quality evidence reports, the U.S. Preventive Services Task Force, the Cochrane database, DynaMed, and Essential Evidence Plus. These patients should be screened six to 12 weeks postpartum for persistently abnormal glucose metabolism, and should undergo screening for diabetes every three years thereafter.
Although insulin has historically been the standard therapy for women with uncontrolled GDM, oral medications are now appropriate first-line therapies as well.2 Options for oral medications include metformin (Glucophage) and glyburide.
Metformin and glyburide cross the placenta but have not been associated with birth defects or short-term adverse neonatal outcomes.2,31,32 However, data on long-term metabolic effects on children with in utero exposure are limited.



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