It might lead to the baby being born early and also could cause seizures or a stroke a blood clot or a bleed in the brain that can lead to brain damage in the woman during labor and delivery.
Women with diabetes have high blood pressure more often than women without diabetes. Listen to this Podcast: Gestational Diabetes. People with diabetes who take insulin or other diabetes medications can develop blood sugar that is too low. Low blood sugar can be very serious, and even fatal, if not treated quickly. Seriously low blood sugar can be avoided if women watch their blood sugar closely and treat low blood sugar early.
Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Facebook Twitter LinkedIn Syndicate. Gestational Diabetes and Pregnancy. When necessary, collaborative care with an obstetrician or perinatologist is advisable. Use of oral hypoglycemic agents to treat gestational diabetes has not been recommended because of concerns about potential teratogenicity and transport of glucose across the placenta causing prolonged neonatal hypoglycemia.
A recent RCT comparing the use of glyburide and insulin in women with gestational diabetes demonstrated that glyburide therapy resulted in comparable maternal outcomes e.
Glyburide therapy was not started before 11 weeks of gestation and was not detected in any of the neonatal cord blood samples. Preliminary evidence from this trial suggests that glyburide may be a safe, effective alternative to insulin in the management of gestational diabetes. Despite these recommendations, many physicians are using glyburide in this setting because of its ease of use compared with insulin.
In a recent prospective cohort study of patients with polycystic ovary syndrome, 33 metformin therapy has been shown to decrease the subsequent incidence of gestational diabetes, reduce first-trimester miscarriage rates, and result in no apparent increase in congenital anomalies. Data on gestational diabetes and an increased risk of fetal demise are conflicting.
The ACOG practice bulletin 15 concludes that evidence is insufficient to determine the optimal antepartum testing regimen in women with gestational diabetes who have relatively normal glucose levels on diet therapy and no other perinatal risk factors.
Acceptable practice patterns for monitoring pregnancies complicated by gestational diabetes range from testing all women beginning at 32 weeks of gestation to no testing until 40 weeks of gestation. The ACOG 15 recommends antenatal testing for patients whose blood glucose levels are not well controlled, who require insulin therapy, or who have concomitant hypertension.
The antenatal testing can be initiated at 32 weeks of gestation. In this situation, no method of antenatal testing has proved superior to others. Community preference may dictate use of the nonstress test, the modified biophysical profile i. In gestational diabetes, shoulder dystocia is the complication most anticipated at the time of delivery.
In one study, 36 this complication occurred in 31 percent of neonates weighing more than 4, g who were delivered vaginally to unclassified mothers with diabetes. No prospective data support the use of cesarean delivery to avoid birth trauma in women who have gestational diabetes. A reasonable approach is to offer elective cesarean delivery to the patient with gestational diabetes and an estimated fetal weight of 4, g or more, based on the patient's history and pelvimetry, and the patient and physician's discussion about the risks and benefits.
There are no indications to pursue delivery before 40 weeks of gestation in patients with good glycemic control unless other maternal or fetal indications are present. The goal of intrapartum management is to maintain normoglycemia in an effort to prevent neonatal hypoglycemia.
Patients with diet-controlled diabetes will not require intrapartum insulin and simply may need to have their glucose level checked on admission for labor and delivery. While patients with insulin-requiring diabetes are in active labor, capillary blood glucose levels should be monitored hourly. Target values are 80 to mg per dL 4.
Women with gestational diabetes rarely require insulin in the postpartum period. As insulin resistance quickly resolves, so does the need for insulin. Patients with diet-controlled diabetes do not need to have their glucose levels checked after delivery. In patients who required insulin therapy during pregnancy, it is reasonable to check fasting and two-hour postprandial glucose levels before hospital discharge.
Because women with gestational diabetes are at high risk for developing type 2 diabetes in the future, they should be tested for diabetes six weeks after delivery via fasting blood glucose measurements on two occasions or a two-hour oral g glucose tolerance test. Normal values for a two-hour glucose tolerance test are less than mg per dL. Values between and mg per dL Screening for diabetes should be repeated annually thereafter, especially in patients who had elevated fasting blood glucose levels during pregnancy.
Breastfeeding improves glycemic control and should be encouraged in women who had gestational diabetes. Contraception should be discussed, because women who have diabetes during one pregnancy are likely to have the same condition in a subsequent pregnancy. There are no limits on the use of hormonal contraception in patients with a history of gestational diabetes. As previously noted, these women also are at increased risk of developing type 2 diabetes in the future.
Patients should be counseled about diet and exercise. By losing weight and exercising, women can significantly decrease their risk of developing diabetes. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more.
Turok received his medical and master of public health degrees from Tufts University, Boston. Louis, and a master of public health degree from the University of Utah. Baxley completed a family practice residency in Anderson, S. Address correspondence to David K. Turok, M. Reprints are not available from the authors. The authors indicate that they do not have any conflicts of interest.
Sources of funding: none reported. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet. Periodic health examination, update: 1. Screening for gestational diabetes mellitus. Screening for gestational diabetes mellitus: recommendation and rationale. Am Fam Physician. Report of the expert committee on the diagnosis and classification of diabetes mellitus.
Diabetes Care. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in women without gestational diabetes. Am J Obstet Gynecol. Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet Gynecol. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Top of the page Actionset. Introduction If you have gestational diabetes and you have not been able to keep your blood sugar levels within a target range , you may need insulin shots. Taking insulin can help prevent high blood sugar. High blood sugar can lead to problems for you and your baby. Insulin is given as a shot into the fatty tissue just under the skin.
In pregnant women, insulin usually is given in the upper arm or thigh. Make sure that you: Have the right dose of insulin, especially if you are giving two types of insulin in the same syringe.
Practice how to give your shot. Store the insulin properly so that each dose will work well. How to prepare and give an insulin shot Your doctor or certified diabetes educator CDE will help you learn to prepare and give yourself insulin shots.
Get ready To get ready to give an insulin shot, follow these steps: Wash your hands with soap and running water. Dry them thoroughly. Gather your supplies. Most people keep their supplies in a bag or kit so they can carry the supplies with them wherever they go. You will need an insulin syringe , your bottle of insulin, and an alcohol wipe or a cotton ball dipped in alcohol.
If you are using an insulin pen, you will need a needle that works with your pen. If the pen is reusable, you may need an insulin cartridge. You may also need an alcohol swab. Check the insulin bottle or cartridge.
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