GESTATIONAL DIABETES

1. glucose intolerance that is present only during pregnancy
2. genetic predisposition to the development of glucose intolerance exists in this population of women
3. 50% risk of developing Type II DM in next 20 years

Risk Factors

1. age > 30
2. previous history of high blood glucose, GDM, or macrosomic infant (> 4.5 kg) p
3. ositive family history (GDM, Type II DM, macrosomic infant)
4. excessive weight gain in pregnancy, prepregnancy obesity
5. baby > 4.5 kg or large for GA
6. previous unexplained stillbirth
7. previous congenital anomaly
8. early preeclampsia or polyhydramnios
9. repeated vaginal candidiasis
10. member of high risk ethnic group
11. multiple gestation

Diagnosis

1. screen at 26 weeks (or earlier) with 50 g oral glucose challenge test if risk factors or glycosuria are present
2. > 7.8 mmol/L at 1 hour is abnormal
3. confirm with 3 hour 100 g oral glucose tolerance test (OGTT)
4. need 2 out of 4 values to be abnormal to diagnose GDM
   
   • fasting: > 5.8 mmol/L
   • 1 hour: > 10.6 mmol/L
   • 2 hour: > 9.2 mmol/L
   • 3 hour: > 8.1 mmol/L

Management of Gestational Diabetes

1. controversial
2. aim to achieve normal blood sugars post-prandial (i.e. < 6.7 mmol/L)
3. start with diabetic diet
4. if blood sugars 2 hours post-prandial are > 6.7, add insulin
5. oral hypoglycemic agents contraindicated in pregnancy
6. fetal monitoring and timing of delivery same as for DM above
7. insulin and diabetic diet should be stopped post-partum
8. follow-up testing recommended postpartum because of increased  risk of overt diabetes (i.e. OGTT at 6 weeks postpartum)
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