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Gestational diabetes mellitus: Obstetrical issues and management

Author
Aaron B Caughey, MD, PhD
Section Editor
Michael F Greene, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Pregnant women are screened for diabetes at 24 to 28 weeks of gestation and an increasing number will be diagnosed with gestational diabetes mellitus (GDM), concomitant with the obesity epidemic. This topic will discuss the obstetrical issues in caring for these women. Management of women with pregestational diabetes (type 1 or type 2 diabetes) and women found to have diabetes early in pregnancy (at the first prenatal visit) is reviewed separately.

The clinician caring for pregnant women with GDM should be knowledgeable about the maternal and fetal risks related to the disorder, antepartum maternal and fetal assessment, use of obstetrical ultrasound to monitor fetal growth and well-being, decision-making about timing and route of delivery, intrapartum obstetric and glycemic management, and postpartum assessment and counseling.

CONSEQUENCES OF GDM

In addition to routine pregnancy issues, the prenatal care of women with gestational diabetes mellitus (GDM) focuses upon identifying and managing conditions that are more common among women with glucose impairment. In contrast to women with pregestational diabetes, women with true GDM typically do not have diabetes-related vasculopathy or an increased risk of infants with congenital malformations because of the short duration of the disorder and late pregnancy onset.

Short-term — Complications of pregnancy more common in GDM include:

Large for gestational age (LGA) infant and macrosomia – LGA and macrosomia are the most common adverse neonatal outcomes associated with GDM. A prospective cohort study observed that accelerated fetal growth may begin as early as 20 to 28 weeks of gestation [1]. Randomized trials have consistently demonstrated that maternal hyperglycemia significantly increases a woman's chances of having a macrosomic or LGA infant [2-5], and excessive maternal weight gain (>40 lbs [18 kg]) doubles the risk [6]. Macrosomia, in turn, is associated with an increased risk of operative delivery (cesarean or instrumental vaginal) and adverse neonatal outcomes, such as shoulder dystocia and its associated complications: brachial plexus injury, fracture, and neonatal depression [7-12]. Truncal asymmetry (disproportion in the ratio of the size of the shoulder or abdomen-to-head) in infants of diabetic mothers also appears to increase the risk [13,14].

                

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Literature review current through: Nov 2016. | This topic last updated: Fri Oct 28 00:00:00 GMT+00:00 2016.
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