Gestational Diabetes Mellitus
Dalia Baliutavičienė, Milda
Gestational diabetes is the most
common metabolic complication of pregnancy. The prevalence in
Women with GDM are a heterogenous
group. For most of them the glucose intolerance occurs in the second trimester
of pregnancy due to increasing levels of pregnancy hormones with growing insulin
resistance and impaired ability to increase insulin secretion. Some pregnant
women are in the early stage of diabetes.
is diagnosed by an oral 75-g glucose tolerance testing (OGTT) according to the
WHO recommendations when the 2-hour value is ≥ 7.8 mmol/l. The OGTT should
be performed between the 24 and 28 week of gestation in the morning after at
least three days of unrestricted diet (greater than 150 g of carbohydrate daily),
usual physical activity, but preceded by an overnight fast of 8-14 hours.
Perinatal complications and sequelae
Management during pregnancy
control, the women may be delivered vaginally at term. Delivery at 38 weeks is
recommended if fetal macrosomia is diagnosed.
who require insulin, blood glucose levels should be monitored at 4-h intervals
during labour. Women with GDM rarely need insulin during labour or postpartum.
Glucose tolerance should be re-evaluated in the mother at 6-12 weeks postpartum to establish a final diagnosis (table 1).
Finally diagnosis after GDM using 2-hour OGTT
normal glucose tolerance (“previous GDM”)
impaired glucose tolerance
If the postpartum evaluation does not indicate diabetes, GTT should be assessed annually. Lifestyle behaviours aimed at reducing weight and increasing physical activity should be recommended.
BE, Coustan DR. Summary and recommendations of the Fourth
International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes
Care 1998;21(suppl 2):B161-7.
College of Obstetricians and Gynecologists. Diabetes and pregnancy: ACOG
Technical Bulletin No 200. Washington, DC: ACOG; 2000.
Diabetes Association. Gestational diabetes mellitus. Diabetes Care 2004;27(suppl