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Gestational diabetes mellitus: Glycemic control and maternal prognosis

Donald R Coustan, MD
Section Editors
David M Nathan, MD
Michael F Greene, MD
Deputy Editor
Vanessa A Barss, MD, FACOG


The general approach to treatment of gestational diabetes mellitus (GDM) will be reviewed here. Screening, diagnosis, and obstetrical management are discussed separately. (See "Diabetes mellitus in pregnancy: Screening and diagnosis" and "Pregestational diabetes mellitus: Obstetrical issues and management".)


Identifying women with GDM is important to minimize maternal and neonatal morbidity. A 2013 systematic review and meta-analysis of randomized trials for the US Preventive Services Task Force found that appropriate management of GDM (nutritional therapy, self blood glucose monitoring, administration of insulin if target blood glucose concentrations are not met with diet alone) resulted in reductions in [1]:

Preeclampsia (relative risk [RR] 0.62, 95% CI 0.43-0.89; 72/1001 [7.2 percent] versus 119/1013 [11.7 percent], three trials)

Birth weight >4000 g (RR 0.50, 95% CI 0.35-0.71; five trials)

Shoulder dystocia (RR 0.42, 95% CI 0.23-0.77; three trials)  

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Literature review current through: Sep 2017. | This topic last updated: Sep 29, 2017.
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  1. Hartling L, Dryden DM, Guthrie A, et al. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013; 159:123.
  2. Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 2012; 35:780.
  3. Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352:2477.
  4. Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361:1339.
  5. Palatnik A, Mele L, Landon MB, et al. Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. Am J Obstet Gynecol 2015; 213:560.e1.
  6. Han S, Crowther CA, Middleton P, Heatley E. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev 2013; :CD009275.
  7. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008; 31 Suppl 1:S61.
  8. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2004; 27 Suppl 1:S88.
  9. Food and Nutrition Board, Institute of Medicine: U.S. Dietary Reference Intakes: Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC, National Academies Press, 2002
  10. The Art and Science of Diabetes Self-Management Education, Mensing, C (Eds), American Association of Diabetes Educators, 2006. p.241.
  11. Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol 1998; 91:600.
  12. Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care 2014; 37:3345.
  13. Peterson CM, Jovanovic-Peterson L. Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes 1991; 40 Suppl 2:172.
  14. Lindsay KL, Brennan L, Kennelly MA, et al. Impact of probiotics in women with gestational diabetes mellitus on metabolic health: a randomized controlled trial. Am J Obstet Gynecol 2015; 212:496.e1.
  15. Reece EA, Hagay Z, Caseria D, et al. Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy? Am J Perinatol 1993; 10:272.
  16. Institute of Medicine, Food and Nutrition Board, Committee on Nutritional Status During Pregnancy, part I: Nutritional Status and Weight Gain. National Academy Press, Washington, DC 2000.
  17. Cheng YW, Chung JH, Kurbisch-Block I, et al. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol 2008; 112:1015.
  18. Scifres C, Feghali M, Althouse AD, et al. Adverse Outcomes and Potential Targets for Intervention in Gestational Diabetes and Obesity. Obstet Gynecol 2015; 126:316.
  19. Peterson CM, Jovanovic-Peterson L. Nutritional management of the obese pregnant woman. Nutrition and the MD 1991; 17:1.
  20. HAPO Study Cooperative Research Group. Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study: associations with maternal body mass index. BJOG 2010; 117:575.
  21. Walkinshaw SA. Dietary regulation for 'gestational diabetes'. Cochrane Database Syst Rev 2000; :CD000070.
  22. Schrader HM, Jovanovic-Peterson L, Bevier WC, Peterson CM. Fasting plasma glucose and glycosylated plasma protein at 24 to 28 weeks of gestation predict macrosomia in the general obstetric population. Am J Perinatol 1995; 12:247.
  23. Bevier WC, Fischer R, Jovanovic L. Treatment of women with an abnormal glucose challenge test (but a normal oral glucose tolerance test) decreases the prevalence of macrosomia. Am J Perinatol 1999; 16:269.
  24. Scholl TO, Sowers M, Chen X, Lenders C. Maternal glucose concentration influences fetal growth, gestation, and pregnancy complications. Am J Epidemiol 2001; 154:514.
  25. Parretti E, Mecacci F, Papini M, et al. Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: correlation with sonographic parameters of fetal growth. Diabetes Care 2001; 24:1319.
  26. Jensen DM, Korsholm L, Ovesen P, et al. Adverse pregnancy outcome in women with mild glucose intolerance: is there a clinically meaningful threshold value for glucose? Acta Obstet Gynecol Scand 2008; 87:59.
  27. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358:1991.
  28. Sermer M, Naylor CD, Gare DJ, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol 1995; 173:146.
  29. Pettitt DJ, McKenna S, McLaughlin C, et al. Maternal glucose at 28 weeks of gestation is not associated with obesity in 2-year-old offspring: the Belfast Hyperglycemia and Adverse Pregnancy Outcome (HAPO) family study. Diabetes Care 2010; 33:1219.
  30. Han S, Crowther CA, Middleton P. Interventions for pregnant women with hyperglycaemia not meeting gestational diabetes and type 2 diabetes diagnostic criteria. Cochrane Database Syst Rev 2012; 1:CD009037.
  31. Werner EF, Froehlich RJ. The Potential Role for Myoinositol in the Prevention of Gestational Diabetes Mellitus. Am J Perinatol 2016; 33:1236.
  32. Gibson WT, Milsom DW, Steven FS, Lowe JS. Collagenolytic cathepsin activity in rabbit peritoneal polymorphonuclear leucocytes. Biochem Soc Trans 1976; 4:627.
  33. Horton ES. Exercise in the treatment of NIDDM. Applications for GDM? Diabetes 1991; 40 Suppl 2:175.
  34. Pedersen O, Beck-Nielsen H, Heding L. Increased insulin receptors after exercise in patients with insulin-dependent diabetes mellitus. N Engl J Med 1980; 302:886.
  35. Schneider SH, Ruderman NB. Exercise and NIDDM. Diabetes Care 1993; 16:54.
  36. Jovanovic-Peterson L, Durak EP, Peterson CM. Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes. Am J Obstet Gynecol 1989; 161:415.
  37. Artal R, Wiswell R, Romem Y. Hormonal responses to exercise in diabetic and nondiabetic pregnant patients. Diabetes 1985; 34 Suppl 2:78.
  38. de Barros MC, Lopes MA, Francisco RP, et al. Resistance exercise and glycemic control in women with gestational diabetes mellitus. Am J Obstet Gynecol 2010; 203:556.e1.
  39. Bung P, Artal R, Khodiguian N, Kjos S. Exercise in gestational diabetes. An optional therapeutic approach? Diabetes 1991; 40 Suppl 2:182.
  40. Avery MD, Leon AS, Kopher RA. Effects of a partially home-based exercise program for women with gestational diabetes. Obstet Gynecol 1997; 89:10.
  41. Ceysens G, Rouiller D, Boulvain M. Exercise for diabetic pregnant women. Cochrane Database Syst Rev 2006; :CD004225.
  42. Barakat R, Pelaez M, Lopez C, et al. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. Br J Sports Med 2013; 47:630.
  43. Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care 2010; 33:e147.
  44. Hawkins JS, Casey BM, Lo JY, et al. Weekly compared with daily blood glucose monitoring in women with diet-treated gestational diabetes. Obstet Gynecol 2009; 113:1307.
  45. Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 180: Gestational Diabetes Mellitus. Obstet Gynecol 2017; 130:e17.
  46. Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007; 30 Suppl 2:S251.
  47. Mendez-Figueroa H, Schuster M, Maggio L, et al. Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring: A Randomized Controlled Trial. Obstet Gynecol 2017; 130:163.
  48. Laird J, McFarland KF. Fasting blood glucose levels and initiation of insulin therapy in gestational diabetes. Endocr Pract 1996; 2:330.
  49. Weisz B, Shrim A, Homko CJ, et al. One hour versus two hours postprandial glucose measurement in gestational diabetes: a prospective study. J Perinatol 2005; 25:241.
  50. Moses RG, Lucas EM, Knights S. Gestational diabetes mellitus. At what time should the postprandial glucose level be monitored? Aust N Z J Obstet Gynaecol 1999; 39:457.
  51. Sivan E, Weisz B, Homko CJ, et al. One or two hours postprandial glucose measurements: are they the same? Am J Obstet Gynecol 2001; 185:604.
  52. Chen R, Yogev Y, Ben-Haroush A, et al. Continuous glucose monitoring for the evaluation and improved control of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2003; 14:256.
  53. Chitayat L, Zisser H, Jovanovic L. Continuous glucose monitoring during pregnancy. Diabetes Technol Ther 2009; 11 Suppl 1:S105.
  54. de Veciana M, Major CA, Morgan MA, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med 1995; 333:1237.
  55. Yu F, Lv L, Liang Z, et al. Continuous glucose monitoring effects on maternal glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus: a prospective cohort study. J Clin Endocrinol Metab 2014; 99:4674.
  56. Nicholson WK, Wilson LM, Witkop CT, et al. Therapeutic management, delivery, and postpartum risk assessment and screening in gestational diabetes. Evid Rep Technol Assess (Full Rep) 2008; :1.
  57. American Diabetes Association. 13. Management of Diabetes in Pregnancy. Diabetes Care 2017; 40:S114.
  58. Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care 2011; 34:1660.
  59. Harmon KA, Gerard L, Jensen DR, et al. Continuous glucose profiles in obese and normal-weight pregnant women on a controlled diet: metabolic determinants of fetal growth. Diabetes Care 2011; 34:2198.
  60. Durnwald CP, Mele L, Spong CY, et al. Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes. Obstet Gynecol 2011; 117:819.
  61. Uvena-Celebrezze J, Fung C, Thomas AJ, et al. Relationship of neonatal body composition to maternal glucose control in women with gestational diabetes mellitus. J Matern Fetal Neonatal Med 2002; 12:396.
  62. Catalano PM, Thomas A, Huston-Presley L, Amini SB. Increased fetal adiposity: a very sensitive marker of abnormal in utero development. Am J Obstet Gynecol 2003; 189:1698.
  63. Langer O, Levy J, Brustman L, et al. Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age? Am J Obstet Gynecol 1989; 161:646.
  64. Griffiths RJ, Vinall PS, Stickland MH, Wales JK. Haemoglobin A1c levels in normal and diabetic pregnancies. Eur J Obstet Gynecol Reprod Biol 1987; 24:195.
  65. Jovanovic L, Savas H, Mehta M, et al. Frequent monitoring of A1C during pregnancy as a treatment tool to guide therapy. Diabetes Care 2011; 34:53.
  66. Mosca A, Paleari R, Dalfrà MG, et al. Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Clin Chem 2006; 52:1138.
  67. Lurie S, Mamet Y. Red blood cell survival and kinetics during pregnancy. Eur J Obstet Gynecol Reprod Biol 2000; 93:185.
  68. Bunn HF, Haney DN, Kamin S, et al. The biosynthesis of human hemoglobin A1c. Slow glycosylation of hemoglobin in vivo. J Clin Invest 1976; 57:1652.
  69. Stehbens JA, Baker GL, Kitchell M. Outcome at ages 1, 3, and 5 years of children born to diabetic women. Am J Obstet Gynecol 1977; 127:408.
  70. Churchill JA, Berendes HW, Nemore J. Neuropsychological deficits in children of diabetic mothers. A report from the Collaborative Sdy of Cerebral Palsy. Am J Obstet Gynecol 1969; 105:257.
  71. Rizzo T, Metzger BE, Burns WJ, Burns K. Correlations between antepartum maternal metabolism and intelligence of offspring. N Engl J Med 1991; 325:911.
  72. Naeye RL, Chez RA. Effects of maternal acetonuria and low pregnancy weight gain on children's psychomotor development. Am J Obstet Gynecol 1981; 139:189.
  73. Metzger BE, Ravnikar V, Vileisis RA, Freinkel N. "Accelerated starvation" and the skipped breakfast in late normal pregnancy. Lancet 1982; 1:588.
  74. Silverman BL, Rizzo TA, Cho NH, Metzger BE. Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Diabetes Care 1998; 21 Suppl 2:B142.
  75. Bonomo M, Cetin I, Pisoni MP, et al. Flexible treatment of gestational diabetes modulated on ultrasound evaluation of intrauterine growth: a controlled randomized clinical trial. Diabetes Metab 2004; 30:237.
  76. Kjos SL, Schaefer-Graf U, Sardesi S, et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Diabetes Care 2001; 24:1904.
  77. Rossi G, Somigliana E, Moschetta M, et al. Adequate timing of fetal ultrasound to guide metabolic therapy in mild gestational diabetes mellitus. Results from a randomized study. Acta Obstet Gynecol Scand 2000; 79:649.
  78. Buchanan TA, Kjos SL, Montoro MN, et al. Use of fetal ultrasound to select metabolic therapy for pregnancies complicated by mild gestational diabetes. Diabetes Care 1994; 17:275.
  79. Balsells M, García-Patterson A, Gich I, Corcoy R. Ultrasound-guided compared to conventional treatment in gestational diabetes leads to improved birthweight but more insulin treatment: systematic review and meta-analysis. Acta Obstet Gynecol Scand 2014; 93:144.
  80. Coustan, DR. Management of gestational diabetes. In: Diabetes in Women, Reece, EA, Coustan, DR, Gabbe, SG (Eds), Lippincott Williams and Wilkins, Philadelphia 2004. p.227.
  81. Lewis SB, Wallin JD, Kuzuya H, et al. Circadian variation of serum glucose, C-peptide immunoreactivity and free insulin normal and insulin-treated diabetic pregnant subjects. Diabetologia 1976; 12:343.
  82. Nachum Z, Ben-Shlomo I, Weiner E, Shalev E. Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial. BMJ 1999; 319:1223.
  83. Mathiesen ER, Hod M, Ivanisevic M, et al. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes. Diabetes Care 2012; 35:2012.
  84. Hod M, McCance DR, Ivanisevic M, et al. Perinatal Outcomes in a Randomized Trial Comparing Insulin Detemir with NPH Insulin in 310 Pregnant Women with Type 1. Abstract 62-LB. American Diabetes Association. 71st Scientific Sessions. June 24 - 28, 2011 San Diego Convention Center - San Diego, California
  85. Pollex EK, Feig DS, Lubetsky A, et al. Insulin glargine safety in pregnancy: a transplacental transfer study. Diabetes Care 2010; 33:29.
  86. Kovo M, Wainstein J, Matas Z, et al. Placental transfer of the insulin analog glargine in the ex vivo perfused placental cotyledon model. Endocr Res 2011; 36:19.
  87. Callesen NF, Damm J, Mathiesen JM, et al. Treatment with the long-acting insulin analogues detemir or glargine during pregnancy in women with type 1 diabetes: comparison of glycaemic control and pregnancy outcome. J Matern Fetal Neonatal Med 2013; 26:588.
  88. Jovanovic L, Pettitt DJ. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Diabetes Care 2007; 30 Suppl 2:S220.
  89. Nicholson W, Bolen S, Witkop CT, et al. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Obstet Gynecol 2009; 113:193.
  90. Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol 2010; 203:457.e1.
  91. Balsells M, García-Patterson A, Solà I, et al. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ 2015; 350:h102.
  92. Camelo Castillo W, Boggess K, Stürmer T, et al. Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000-2011. Obstet Gynecol 2014; 123:1177.
  93. Brown J, Martis R, Hughes B, et al. Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 2017; 1:CD011967.
  94. Nachum Z, Zafran N, Salim R, et al. Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study. Diabetes Care 2017; 40:332.
  95. Langer O, Conway DL, Berkus MD, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343:1134.
  96. Elliott BD, Langer O, Schenker S, Johnson RF. Insignificant transfer of glyburide occurs across the human placenta. Am J Obstet Gynecol 1991; 165:807.
  97. Elliott BD, Schenker S, Langer O, et al. Comparative placental transport of oral hypoglycemic agents in humans: a model of human placental drug transfer. Am J Obstet Gynecol 1994; 171:653.
  98. Hebert MF, Ma X, Naraharisetti SB, et al. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther 2009; 85:607.
  99. Schwartz R, et al. Transplacental transfer of glyburide: is it clinically significant? Am J Obstet Gynecol 2013; 208:S25.
  100. Schwartz RA, Rosenn B, Aleksa K, Koren G. Glyburide Transport Across the Human Placenta. Obstet Gynecol 2015.
  101. Caritis SN, Hebert MF. A pharmacologic approach to the use of glyburide in pregnancy. Obstet Gynecol 2013; 121:1309.
  102. Harper LM, Glover AV, Biggio JR, Tita A. Predicting failure of glyburide therapy in gestational diabetes. J Perinatol 2016; 36:347.
  103. Butalia S, Gutierrez L, Lodha A, et al. Short- and long-term outcomes of metformin compared with insulin alone in pregnancy: a systematic review and meta-analysis. Diabet Med 2017; 34:27.
  104. Romero R, Erez O, Hüttemann M, et al. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity. Am J Obstet Gynecol 2017; 217:282.
  105. Rena G, Hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia 2017.
  106. Glueck CJ, Wang P, Kobayashi S, et al. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril 2002; 77:520.
  107. Glueck CJ, Pranikoff J, Aregawi D, Wang P. Prevention of gestational diabetes by metformin plus diet in patients with polycystic ovary syndrome. Fertil Steril 2008; 89:625.
  108. Vanky E, Stridsklev S, Heimstad R, et al. Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study. J Clin Endocrinol Metab 2010; 95:E448.
  109. Syngelaki A, Nicolaides KH, Balani J, et al. Metformin versus Placebo in Obese Pregnant Women without Diabetes Mellitus. N Engl J Med 2016; 374:434.
  110. Chiswick C, Reynolds RM, Denison F, et al. Effect of metformin on maternal and fetal outcomes in obese pregnant women (EMPOWaR): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2015; 3:778.
  111. Vanky E, Zahlsen K, Spigset O, Carlsen SM. Placental passage of metformin in women with polycystic ovary syndrome. Fertil Steril 2005; 83:1575.
  112. Wouldes TA, Battin M, Coat S, et al. Neurodevelopmental outcome at 2 years in offspring of women randomised to metformin or insulin treatment for gestational diabetes. Arch Dis Child Fetal Neonatal Ed 2016.
  113. Rowan JA, Rush EC, Obolonkin V, et al. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition at 2 years of age. Diabetes Care 2011; 34:2279.
  114. Barbour LA, Van Pelt RE, Brumbaugh DE, et al. Comment on: Rowan et al. Metformin in Gestational diabetes: The Offspring Follow-Up (MiG TOFU): body composition at 2 years of age. Diabetes Care 2011;34:2279-2284. Diabetes Care 2012; 35:e28; author reply e30.
  115. Feig DS, Moses RG. Metformin therapy during pregnancy: good for the goose and good for the gosling too? Diabetes Care 2011; 34:2329.
  116. Silverman BL, Rizzo T, Green OC, et al. Long-term prospective evaluation of offspring of diabetic mothers. Diabetes 1991; 40 Suppl 2:121.
  117. Garcia-Bournissen F, Feig DS, Koren G. Maternal-fetal transport of hypoglycaemic drugs. Clin Pharmacokinet 2003; 42:303.
  118. Kemball ML, McIver C, Milner RD, et al. Neonatal hypoglycaemia in infants of diabetic mothers given sulphonylurea drugs in pregnancy. Arch Dis Child 1970; 45:696.
  119. Zucker P, Simon G. Prolonged symptomatic neonatal hypoglycemia associated with maternal chlorpropamide therapy. Pediatrics 1968; 42:824.
  120. Chan LY, Yeung JH, Lau TK. Placental transfer of rosiglitazone in the first trimester of human pregnancy. Fertil Steril 2005; 83:955.
  121. Tieu J, Bain E, Middleton P, Crowther CA. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes. Cochrane Database Syst Rev 2013; :CD010211.
  122. Nicklas JM, Zera CA, England LJ, et al. A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol 2014; 124:563.
  123. Phelan S, Phipps MG, Abrams B, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Am J Clin Nutr 2014; 99:302.
  124. Philipson EH, Super DM. Gestational diabetes mellitus: does it recur in subsequent pregnancy? Am J Obstet Gynecol 1989; 160:1324.
  125. Moses RG. The recurrence rate of gestational diabetes in subsequent pregnancies. Diabetes Care 1996; 19:1348.
  126. MacNeill S, Dodds L, Hamilton DC, et al. Rates and risk factors for recurrence of gestational diabetes. Diabetes Care 2001; 24:659.
  127. Getahun D, Fassett MJ, Jacobsen SJ. Gestational diabetes: risk of recurrence in subsequent pregnancies. Am J Obstet Gynecol 2010; 203:467.e1.
  128. Varner MW, Rice MM, Landon MB, et al. Pregnancies After the Diagnosis of Mild Gestational Diabetes Mellitus and Risk of Cardiometabolic Disorders. Obstet Gynecol 2017; 129:273.
  129. Catalano PM, Vargo KM, Bernstein IM, Amini SB. Incidence and risk factors associated with abnormal postpartum glucose tolerance in women with gestational diabetes. Am J Obstet Gynecol 1991; 165:914.
  130. Kjos SL, Buchanan TA, Greenspoon JS, et al. Gestational diabetes mellitus: the prevalence of glucose intolerance and diabetes mellitus in the first two months post partum. Am J Obstet Gynecol 1990; 163:93.
  131. Retnakaran R, Qi Y, Connelly PW, et al. Glucose intolerance in pregnancy and postpartum risk of metabolic syndrome in young women. J Clin Endocrinol Metab 2010; 95:670.
  132. Retnakaran R, Qi Y, Connelly PW, et al. The graded relationship between glucose tolerance status in pregnancy and postpartum levels of low-density-lipoprotein cholesterol and apolipoprotein B in young women: implications for future cardiovascular risk. J Clin Endocrinol Metab 2010; 95:4345.
  133. Heitritter SM, Solomon CG, Mitchell GF, et al. Subclinical inflammation and vascular dysfunction in women with previous gestational diabetes mellitus. J Clin Endocrinol Metab 2005; 90:3983.
  134. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373:1773.
  135. Feig DS, Zinman B, Wang X, Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ 2008; 179:229.
  136. Cheung NW, Byth K. Population health significance of gestational diabetes. Diabetes Care 2003; 26:2005.
  137. Baptiste-Roberts K, Barone BB, Gary TL, et al. Risk factors for type 2 diabetes among women with gestational diabetes: a systematic review. Am J Med 2009; 122:207.
  138. Dornhorst A, Bailey PC, Anyaoku V, et al. Abnormalities of glucose tolerance following gestational diabetes. Q J Med 1990; 77:1219.
  139. O'Sullivan JB. Diabetes mellitus after GDM. Diabetes 1991; 40 Suppl 2:131.
  140. O'Sullivan JB. Body weight and subsequent diabetes mellitus. JAMA 1982; 248:949.
  141. Stangenberg M, Agarwal N, Rahman F, et al. Frequency of HLA genes and islet cell antibodies (ICA) and result of postpartum oral glucose tolerance tests (OGTT) in Saudi Arabian women with abnormal OGTT during pregnancy. Diabetes Res 1990; 14:9.
  142. Damm P, Kühl C, Bertelsen A, Mølsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol 1992; 167:607.
  143. Löbner K, Knopff A, Baumgarten A, et al. Predictors of postpartum diabetes in women with gestational diabetes mellitus. Diabetes 2006; 55:792.
  144. Russell C, Dodds L, Armson BA, et al. Diabetes mellitus following gestational diabetes: role of subsequent pregnancy. BJOG 2008; 115:253.
  145. Peters RK, Kjos SL, Xiang A, Buchanan TA. Long-term diabetogenic effect of single pregnancy in women with previous gestational diabetes mellitus. Lancet 1996; 347:227.
  146. Ferber KM, Keller E, Albert ED, Ziegler AG. Predictive value of human leukocyte antigen class II typing for the development of islet autoantibodies and insulin-dependent diabetes postpartum in women with gestational diabetes. J Clin Endocrinol Metab 1999; 84:2342.
  147. Mauricio D, Balsells M, Morales J, et al. Islet cell autoimmunity in women with gestational diabetes and risk of progression to insulin-dependent diabetes mellitus. Diabetes Metab Rev 1996; 12:275.
  148. Järvelä IY, Juutinen J, Koskela P, et al. Gestational diabetes identifies women at risk for permanent type 1 and type 2 diabetes in fertile age: predictive role of autoantibodies. Diabetes Care 2006; 29:607.
  149. Shah BR, Retnakaran R, Booth GL. Increased risk of cardiovascular disease in young women following gestational diabetes mellitus. Diabetes Care 2008; 31:1668.
  150. Carr DB, Utzschneider KM, Hull RL, et al. Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes Care 2006; 29:2078.
  151. Kessous R, Shoham-Vardi I, Pariente G, et al. An association between gestational diabetes mellitus and long-term maternal cardiovascular morbidity. Heart 2013; 99:1118.
  152. Fadl H, Magnuson A, Östlund I, et al. Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case-control study. BJOG 2014; 121:1530.
  153. Retnakaran R, Shah BR. Mild glucose intolerance in pregnancy and risk of cardiovascular disease: a population-based cohort study. CMAJ 2009; 181:371.
  154. https://www.nice.org.uk/guidance/ng3 (Accessed on April 16, 2015).
  155. Gunderson EP, Crites Y, Chiang V, et al. Influence of breastfeeding during the postpartum oral glucose tolerance test on plasma glucose and insulin. Obstet Gynecol 2012; 120:136.
  156. Balk EM, Earley A, Raman G, et al. Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Ann Intern Med 2015; 163:437.
  157. Ratner RE, Christophi CA, Metzger BE, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008; 93:4774.
  158. Bao W, Tobias DK, Bowers K, et al. Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study. JAMA Intern Med 2014; 174:1047.
  159. Physical Activity Guidelines Committee. Physical Activity Guidelines Advisory Committee Report. Washington, DC: Department of Health and Human Services; 2008: http://www.health.gov/paguidelines/report.