Obstetrical challenges in caring for pregnant women with gestational diabetes mellitus (GDM) include knowledge of the maternal and fetal risks related to the disorder, antepartum maternal and fetal monitoring, use of obstetrical ultrasound to monitor fetal growth and well-being, decisions about timing and route of delivery, intrapartum obstetric and glycemic management, and postpartum assessment.
This topic will address issues related to obstetric management of women diagnosed with GDM after screening at 24 to 28 weeks of gestation. Screening, diagnosis, and glycemic management of women with gestational diabetes are discussed separately. (See "Screening and diagnosis of diabetes mellitus during pregnancy" and "Medical management and follow-up of gestational diabetes mellitus".)
Obstetrical and medical management of pregnant women with type 1 and type 2 diabetes mellitus are also discussed separately. (See "Obstetrical management of pregnancy complicated by pregestational diabetes mellitus" and "Medical management of type 1 and type 2 diabetes mellitus in pregnant women" and "Pregnancy risks in women with type 1 and type 2 diabetes mellitus" and "Prepregnancy evaluation and management of women with type 1 or type 2 diabetes mellitus".)
FOCUS OF PRENATAL CARE
In addition to routine pregnancy issues, the prenatal care of women with GDM focuses upon identifying and managing conditions that are more common among women with glucose impairment. Maintaining good glycemic control is the key intervention for reducing the frequency and/or severity of these conditions. In contrast to women with pregestational diabetes, women with GDM typically do not have overt vasculopathy or an increased risk of infants with congenital malformations.
Conditions more common in GDM include: