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Learn more about Teeth whitening solutions Self-Management Education and Support Services. Blood sugar that is not well controlled in a woman with gestational diabetes Insukin lead to Chromium browser for secure browsing for diabefes pregnant woman and diabwtes baby:.
Besides causing discomfort to the woman during the last diaabetes months of Hydration for youth athletes, an extra-large baby Insulin and gestational diabetes lead to problems during delivery for both diabwtes mother and the baby. The mother might need a An to deliver the baby. The Fuel Usage Tracking can be born with nerve damage due Insulin and gestational diabetes pressure ans the shoulder during delivery.
A woman who has diabetes that is Health well Insuin has a higher chance an needing a C-section to deliver the baby. When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth.
It is a serious problem that needs to be watched closely and managed by her doctor. High blood pressure can cause harm to both the woman and her unborn baby. 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.
Women who had gestational diabetes or who develop prediabetes can also learn more about the National Diabetes Prevention Program National DPPCDC-recognized lifestyle change programs. To find a CDC-recognized lifestyle change class near you, or join one of the online programs.
Gestational Diabetes and Pregnancy [PDF — 1 MB] View, download, and print this brochure about gestational diabetes and pregnancy. Skip directly to site content Skip directly to search. Español Other Languages. Gestational Diabetes and Pregnancy.
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: Insulin and gestational diabetes| Gestational Diabetes | Do not over tighten. Take off the outer needle cap. Do not throw away. Then, pull off the inner needle cap and throw away. Do a safety test to make sure all air bubbles are out of the needle. Turn the dose knob on the end of the pen to the first 1 or 2 clicks. Hold the pen with the needle pointing up. Push the injection button. Look at the needle to be sure fluid comes out. Repeat if needed, until a drop appears. It may take several tries to see fluid come out of a new pen. Turn the dose knob to your insulin dose. Choose an injection site. Then, clean the site with an alcohol swab or soap, water, and a paper towel. Let the site dry. To reduce the risk of infection at the site, do not touch the uncapped needle anything. If this happens, use a new needle. Push the needle into the skin at a degree angle. Be sure the needle is all the way in your body. Push down and hold the injection button until it stops. Hold it for 5 to 10 seconds. Pull the needle out of your body. Cover the needle with the outer needle cap. Twist off the needle. Put the used needle in a medical sharp or puncture-proof container, such as a liquid detergent bottle. Put the pen cap back on the pen. How do I give myself an injection? Wipe the injection site with alcohol or soap and water. Hold the syringe straight up and down and push the needle into the injection site at a degree angle. Push down the plunger at a steady rate until the syringe is empty. Where can I inject insulin when I'm pregnant? In one study, an additional pregnancy increased the rate ratio of type 2 diabetes threefold compared with individuals without an additional pregnancy RR 3. The authors hypothesized that repeated episodes of insulin resistance contribute to the decline in beta-cell function that leads to type 2 diabetes in many high-risk individuals. Parity, large birth weight, and diabetes in a first-degree relative are less correlated with later diabetes. Specific human leukocyte antigen HLA alleles DR3 or DR4 may predispose to the development of type 1 diabetes postpartum, as does the presence of islet-cell autoantibodies [ ] or antibodies against glutamic acid decarboxylase or insulinoma antigen 2. GDM in lean pregnant people, need for insulin treatment of GDM, diabetic ketoacidosis during pregnancy, and postpartum hyperglycemia also suggest preexisting unrecognized type 1 diabetes or high risk of developing type 1 diabetes [ ]. Although testing for antibodies is not routinely recommended, it is important for clinicians to be aware of this association. Distinguishing type 1 from type 2 diabetes, and monogenic forms of diabetes eg, maturity-onset diabetes of the young [MODY] from type 1 and type 2 diabetes, is reviewed in detail elsewhere. See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Differentiating the cause' and "Classification of diabetes mellitus and genetic diabetic syndromes". In one study of patients with mild GDM ie, normal fasting glucose level on glucose tolerance test [GTT] , approximately one-third developed metabolic syndrome within 5 to 10 years after giving birth [ ]. Even mild glucose impairment defined as an abnormal 50 g one-hour GTT followed by a normal g three-hour GTT appears to identify individuals at increased risk of future development of CVD, usually myocardial infarction or stroke [ ]. In these studies, the increased risk was related to development of type 2 diabetes later in life. More recent data demonstrate that the increased risk of CVD in patients with a prior history of GDM may be independent of the development of type 2 diabetes. Meta-regression analysis showed that the rates of incident type 2 diabetes across the studies did not affect this risk and when individuals with type 2 diabetes were excluded, GDM was still associated with an increased risk of future CVD RR 1. The increased mortality risk was primarily due to CVD 0. Testing — Long-term follow-up for development of type 2 diabetes is routinely recommended for individuals with GDM, given their high risk for developing the disorder [ 24,43 ]. GTT — A common approach is to order a GTT to be performed 4 to 12 weeks after giving birth, using the 75 g GTT, as recommended by the American Diabetes Association ADA [ 24 ]. Criteria for diagnosis of diabetes and prediabetes are shown in the tables table 2A-B. Suboptimal adherence has been attributed to not ordering the test, lack of patient follow-up for postpartum care, patient burden associated with a fasting and a two-hour laboratory procedure, and patient difficulty with childcare [ ]. There is increasing evidence that performing the test while the patient is still hospitalized after birth increases adherence to nearly percent and provides reliable results [ , ]. At one year postpartum, the A1C was consistent with impaired glucose metabolism in 35 percent and diabetes in 4 percent of individuals tested. Fasting glucose — A fasting plasma glucose level is a reasonable alternative to the GTT but does not allow for diagnosis of impaired glucose tolerance. A glycated hemoglobin A1C can be performed in patients in whom obtaining a fasting specimen is especially inconvenient but performs less well for diagnosis of diabetes or prediabetes in postpartum patients because of increased peripartum red cell turnover [ ]. See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Diagnostic tests'. They should have yearly assessment of glycemic status. Approaches to prevention of type 2 diabetes are reviewed in detail separately. See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Prediabetes' and "Prevention of type 2 diabetes mellitus". Higher intensity and longer duration of breastfeeding during the first two years postpartum is associated with a reduced risk of developing type 2 diabetes in observational studies. See "Gestational diabetes mellitus: Obstetric issues and management", section on 'Breastfeeding'. They should also be given advice regarding contraception and the planning of future pregnancies, especially the importance of good glycemic management prior to conception. See "Overview of general medical care in nonpregnant adults with diabetes mellitus" and "Pregestational preexisting diabetes: Preconception counseling, evaluation, and management". See 'Recurrence' above and 'Long-term risk' above. Lifestyle interventions are beneficial for reducing the incidence of type 2 diabetes in persons with prediabetes [ ] and these interventions diet and exercise, achieving a normal body mass index, avoiding smoking and excessive alcohol intake also appear to be beneficial in patients with a history of GDM, whether or not they meet criteria for prediabetes [ ]. The annual incidence of diabetes may be reduced by 30 to 50 percent or more compared with no intervention [ , ]. Pharmacotherapy eg, metformin , pioglitazone may also have a role in preventing future type 2 diabetes. In a multicenter randomized trial, both intensive lifestyle and metformin therapy reduced the incidence of future diabetes by approximately 50 percent compared with placebo in patients with a history of GDM; metformin was much more effective than lifestyle intervention in parous patients with previous GDM [ ]. This topic is discussed in detail separately. See "Prevention of type 2 diabetes mellitus". Reassessment of glycemic status should be undertaken at a minimum of every three years eg, every one to three years [ 24 ]. More frequent assessment may be important in patients who may become pregnant again, since early detection of diabetes is important to preconception and early prenatal care. More frequent screening every one or two years may also be indicated in patients with other risk factors for diabetes, such as family history of diabetes, obesity, and need for pharmacotherapy during pregnancy. The best means of follow-up testing has not been defined. The two-hour 75 g oral GTT is the more sensitive test for diagnosis of diabetes and impaired glucose tolerance in most populations, but the fasting plasma glucose is more convenient, specific, and reproducible, and less expensive. A1C is convenient and the preferred test for patients who have not fasted overnight. See "Screening for type 2 diabetes mellitus", section on 'Screening tests'. See "Overview of primary prevention of cardiovascular disease". Follow-up of patients not screened for GDM — For patients who did not undergo screening for GDM, but diabetes is suspected postpartum because of newborn outcome eg, hypoglycemia, macrosomia, congenital anomalies , a postpartum GTT may be considered. A normal postpartum GTT excludes the presence of type 1 or type 2 diabetes or prediabetes; it does not exclude the possibility of GDM during pregnancy and the future risks associated with this diagnosis. Indications for screening and tests used for screening are discussed separately. See "Screening for type 2 diabetes mellitus". SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in pregnancy". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest. We suggest glucose self-monitoring before breakfast and at one or at two hours after the beginning of each meal. See 'Glucose monitoring' above. See 'Can the frequency of self-monitoring be reduced? Moderate exercise also improves glycemic control and should be part of the treatment plan for patients with no medical or obstetric contraindications to this level of physical activity. See 'Rationale for treatment' above and 'Exercise' above. Calories are generally divided over three meals and two to four snacks per day and are composed of approximately 40 percent carbohydrate, 20 percent protein, and 40 percent fat. Gestational weight gain recommendations are shown in the table table 1. See 'Medical nutritional therapy' above. Pharmacotherapy can reduce the occurrence of macrosomia and large for gestational age in newborns. See 'Indications for pharmacotherapy' above. We start with the simplest insulin regimen likely to be effective based on the glucose levels recorded in the patient's blood glucose log and increase the complexity as needed. An alternative approach based on both patient weight and glucose levels is somewhat more complex and likely most appropriate for individuals whose glucose levels are not well managed with simpler paradigms. See 'Insulin' above. The long-term effects of transplacental passage of noninsulin antihyperglycemic agents are not known. See 'Oral hypoglycemic agents' above. Testing can be performed while the patient is still in the hospital after giving birth. Otherwise it is performed 4 to 12 weeks postpartum and, if results are normal, at least every three years thereafter. See 'Maternal prognosis' above. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Gestational diabetes mellitus: Glucose management and maternal prognosis. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Author: Celeste Durnwald, MD Section Editors: David M Nathan, MD Erika F Werner, MD, MS Deputy Editor: Vanessa A Barss, MD, FACOG Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Nov 16, There were no significant maternal or neonatal harms from treatment of GDM. Insulin Dose — The insulin dose required to achieve target glucose levels varies among individuals, but the majority of studies have reported a total dose ranging from 0. Follow-up Testing — Long-term follow-up for development of type 2 diabetes is routinely recommended for individuals with GDM, given their high risk for developing the disorder [ 24,43 ]. Electronic address: pubs smfm. SMFM Statement: Pharmacological treatment of gestational diabetes. Am J Obstet Gynecol ; B2. Catalano PM, McIntyre HD, Cruickshank JK, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care ; Crowther CA, Hiller JE, Moss JR, et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med ; HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. Han S, Crowther CA, Middleton P. Interventions for pregnant women with hyperglycaemia not meeting gestational diabetes and type 2 diabetes diagnostic criteria. Cochrane Database Syst Rev ; 1:CD Durnwald CP, Mele L, Spong CY, et al. Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes. Obstet Gynecol ; Uvena-Celebrezze J, Fung C, Thomas AJ, et al. Relationship of neonatal body composition to maternal glucose control in women with gestational diabetes mellitus. J Matern Fetal Neonatal Med ; Catalano PM, Thomas A, Huston-Presley L, Amini SB. Increased fetal adiposity: a very sensitive marker of abnormal in utero development. Am J Obstet Gynecol ; Moss JR, Crowther CA, Hiller JE, et al. Costs and consequences of treatment for mild gestational diabetes mellitus - evaluation from the ACHOIS randomised trial. BMC Pregnancy Childbirth ; US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA ; Pillay J, Donovan L, Guitard S, et al. Screening for Gestational Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Poprzeczny AJ, Louise J, Deussen AR, Dodd JM. The mediating effects of gestational diabetes on fetal growth and adiposity in women who are overweight and obese: secondary analysis of the LIMIT randomised trial. BJOG ; Landon MB, Rice MM, Varner MW, et al. Mild gestational diabetes mellitus and long-term child health. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care ; 31 Suppl 1:S Landon MB, Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. Hernandez TL, Brand-Miller JC. Nutrition Therapy in Gestational Diabetes Mellitus: Time to Move Forward. Yamamoto JM, Kellett JE, Balsells M, et al. Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight. Han S, Middleton P, Shepherd E, et al. Different types of dietary advice for women with gestational diabetes mellitus. Cochrane Database Syst Rev ; 2:CD Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract ; Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition ; Jovanovic-Peterson L, Peterson CM. Dietary manipulation as a primary treatment strategy for pregnancies complicated by diabetes. J Am Coll Nutr ; Reece EA, Hagay Z, Caseria D, et al. Do fiber-enriched diabetic diets have glucose-lowering effects in pregnancy? Am J Perinatol ; Okesene-Gafa KA, Moore AE, Jordan V, et al. Probiotic treatment for women with gestational diabetes to improve maternal and infant health and well-being. Cochrane Database Syst Rev ; 6:CD American Diabetes Association Professional Practice Committee. Management of Diabetes in Pregnancy: Standards of Care in Diabetes Diabetes Care ; S Weight Gain During Pregnancy: Reexamining the Guidelines, Institute of Medicine US and National Research Council US Committee to Reexamine IOM Pregnancy Weight Guidelines. Ed , National Academies Press US The Art and Science of Diabetes Self-Management Education, Mensing C Ed , American Association of Diabetes Educators, Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of carbohydrate restriction in patients with diet-controlled gestational diabetes. Peterson CM, Jovanovic-Peterson L. Percentage of carbohydrate and glycemic response to breakfast, lunch, and dinner in women with gestational diabetes. Diabetes ; 40 Suppl Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Cheng YW, Chung JH, Kurbisch-Block I, et al. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Brown J, Ceysens G, Boulvain M. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Laird J, McFarland KF. Fasting blood glucose levels and initiation of insulin therapy in gestational diabetes. Endocr Pract ; Weisz B, Shrim A, Homko CJ, et al. One hour versus two hours postprandial glucose measurement in gestational diabetes: a prospective study. J Perinatol ; Moses RG, Lucas EM, Knights S. Gestational diabetes mellitus. At what time should the postprandial glucose level be monitored? Aust N Z J Obstet Gynaecol ; Sivan E, Weisz B, Homko CJ, et al. One or two hours postprandial glucose measurements: are they the same? de Veciana M, Major CA, Morgan MA, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. Hawkins JS, Casey BM, Lo JY, et al. Weekly compared with daily blood glucose monitoring in women with diet-treated gestational diabetes. Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care ; 30 Suppl 2:S Mendez-Figueroa H, Schuster M, Maggio L, et al. Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring: A Randomized Controlled Trial. Raman P, Shepherd E, Dowswell T, et al. Different methods and settings for glucose monitoring for gestational diabetes during pregnancy. Cochrane Database Syst Rev ; CD Hofer OJ, Martis R, Alsweiler J, Crowther CA. Different intensities of glycaemic control for women with gestational diabetes mellitus. ACOG Practice Bulletin No. Obstet Gynecol ; e Hernandez TL, Friedman JE, Van Pelt RE, Barbour LA. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Griffiths RJ, Vinall PS, Stickland MH, Wales JK. Haemoglobin A1c levels in normal and diabetic pregnancies. Eur J Obstet Gynecol Reprod Biol ; Jovanovic L, Savas H, Mehta M, et al. Frequent monitoring of A1C during pregnancy as a treatment tool to guide therapy. Mosca A, Paleari R, Dalfrà MG, et al. Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Clin Chem ; Lurie S, Mamet Y. Red blood cell survival and kinetics during pregnancy. Bunn HF, Haney DN, Kamin S, et al. The biosynthesis of human hemoglobin A1c. Slow glycosylation of hemoglobin in vivo. J Clin Invest ; Bergenstal RM, Gal RL, Connor CG, et al. Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels. Ann Intern Med ; Pinto ME, Villena JE. Diabetic ketoacidosis during gestational diabetes. A case report. Diabetes Res Clin Pract ; e Graham UM, Cooke IE, McCance DR. A case of euglyacemic diabetic ketoacidosis in a patient with gestational diabetes mellitus. Obstet Med ; Robinson HL, Barrett HL, Foxcroft K, et al. Prevalence of maternal urinary ketones in pregnancy in overweight and obese women. Stehbens JA, Baker GL, Kitchell M. Outcome at ages 1, 3, and 5 years of children born to diabetic women. Churchill JA, Berendes HW, Nemore J. Neuropsychological deficits in children of diabetic mothers. A report from the Collaborative Sdy of Cerebral Palsy. Rizzo T, Metzger BE, Burns WJ, Burns K. Correlations between antepartum maternal metabolism and intelligence of offspring. Naeye RL, Chez RA. Effects of maternal acetonuria and low pregnancy weight gain on children's psychomotor development. Knopp RH, Magee MS, Raisys V, Benedetti T. Metabolic effects of hypocaloric diets in management of gestational diabetes. Langer O, Levy J, Brustman L, et al. Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age? Kjos SL, Schaefer-Graf U, Sardesi S, et al. A randomized controlled trial using glycemic plus fetal ultrasound parameters versus glycemic parameters to determine insulin therapy in gestational diabetes with fasting hyperglycemia. Nicholson WK, Wilson LM, Witkop CT, et al. Therapeutic management, delivery, and postpartum risk assessment and screening in gestational diabetes. Evid Rep Technol Assess Full Rep ; Harrison RK, Cruz M, Wong A, et al. The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus. Balsells M, García-Patterson A, Gich I, Corcoy R. Ultrasound-guided compared to conventional treatment in gestational diabetes leads to improved birthweight but more insulin treatment: systematic review and meta-analysis. Acta Obstet Gynecol Scand ; Dunne F, Newman C, Alvarez-Iglesias A, et al. Early Metformin in Gestational Diabetes: A Randomized Clinical Trial. National Institute for Health and Care Excellence. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. February 25, ; NICE Guideline 3: version 2. Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics FIGO Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet ; Suppl 3:S Harper LM, Glover AV, Biggio JR, Tita A. Predicting failure of glyburide therapy in gestational diabetes. Nicholson W, Bolen S, Witkop CT, et al. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Dhulkotia JS, Ola B, Fraser R, Farrell T. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Balsells M, García-Patterson A, Solà I, et al. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ ; h Brown J, Grzeskowiak L, Williamson K, et al. Insulin for the treatment of women with gestational diabetes. Tarry-Adkins JL, Aiken CE, Ozanne SE. Comparative impact of pharmacological treatments for gestational diabetes on neonatal anthropometry independent of maternal glycaemic control: A systematic review and meta-analysis. PLoS Med ; e Butalia S, Gutierrez L, Lodha A, et al. Short- and long-term outcomes of metformin compared with insulin alone in pregnancy: a systematic review and meta-analysis. Diabet Med ; Brown J, Martis R, Hughes B, et al. Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes. Neonatal, infant, and childhood growth following metformin versus insulin treatment for gestational diabetes: A systematic review and meta-analysis. Sénat MV, Affres H, Letourneau A, et al. Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes: A Randomized Clinical Trial. Ji J, He Z, Yang Z, et al. Comparing the efficacy and safety of insulin detemir versus neutral protamine hagedorn insulin in treatment of diabetes during pregnancy: a randomized, controlled study. BMJ Open Diabetes Res Care ; 8. Nachum Z, Ben-Shlomo I, Weiner E, Shalev E. Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial. BMJ ; Mathiesen ER, Hod M, Ivanisevic M, et al. Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in pregnant women with type 1 diabetes. Hod M, McCance DR, Ivanisevic M, et al. Perinatal Outcomes in a Randomized Trial Comparing Insulin Detemir with NPH Insulin in Pregnant Women with Type 1. Abstract LB. American Diabetes Association. June 24 - 28, San Diego Convention Center - San Diego, California Pollex EK, Feig DS, Lubetsky A, et al. Insulin glargine safety in pregnancy: a transplacental transfer study. Kovo M, Wainstein J, Matas Z, et al. Placental transfer of the insulin analog glargine in the ex vivo perfused placental cotyledon model. Endocr Res ; Suffecool K, Rosenn B, Niederkofler EE, et al. Insulin detemir does not cross the human placenta. Diabetes Care ; e Callesen NF, Damm J, Mathiesen JM, et al. Treatment with the long-acting insulin analogues detemir or glargine during pregnancy in women with type 1 diabetes: comparison of glycaemic control and pregnancy outcome. Mathiesen ER, Ali N, Alibegovic AC, et al. Risk of Major Congenital Malformations or Perinatal or Neonatal Death With Insulin Detemir Versus Other Basal Insulins in Pregnant Women With Preexisting Diabetes: The Real-World EVOLVE Study. Jovanovic L, Pettitt DJ. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Kalafat E, Sukur YE, Abdi A, et al. Metformin for prevention of hypertensive disorders of pregnancy in women with gestational diabetes or obesity: systematic review and meta-analysis of randomized trials. Ultrasound Obstet Gynecol ; Nachum Z, Zafran N, Salim R, et al. Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus: A Randomized Controlled Study. Hebert MF, Ma X, Naraharisetti SB, et al. Are we optimizing gestational diabetes treatment with glyburide? The pharmacologic basis for better clinical practice. Clin Pharmacol Ther ; Schwartz RA, Rosenn B, Aleksa K, Koren G. Glyburide transport across the human placenta. Bouchghoul H, Alvarez JC, Verstuyft C, et al. Transplacental transfer of glyburide in women with gestational diabetes and neonatal hypoglycemia risk. PLoS One ; e Barbour LA, Scifres C, Valent AM, et al. A cautionary response to SMFM statement: pharmacological treatment of gestational diabetes. Wouldes TA, Battin M, Coat S, et al. Arch Dis Child Fetal Neonatal Ed Landi SN, Radke S, Engel SM, et al. Association of Long-term Child Growth and Developmental Outcomes With Metformin vs Insulin Treatment for Gestational Diabetes. JAMA Pediatr ; Rowan JA, Rush EC, Plank LD, et al. Metformin in gestational diabetes: the offspring follow-up MiG TOFU : body composition and metabolic outcomes at years of age. |
| Insulin for gestational diabetes | N Insulin and gestational diabetes J Citrus fruit desserts ; vestational This test is called an oral glucose Insulkn test GTT. It is Hydration for youth athletes the sugar level in your blood is too low. Rowan JA, Rush EC, Plank LD, et al. To submit feedback about this web page, please enter your comments, suggestions, compliments or questions in the form below. |
| Gestational diabetes - Treatment - NHS | Peterson CM, Jovanovic-Peterson L. Insulin syringes Insuulin for preparing a single dose of diabehes Insulin and gestational diabetes to gestaational a mixed Insulin and gestational diabetes geststional insulin Diabstes injection areas for gsstational diabetes How Inulin give an insulin injection into the arm How Flaxseed for brain health use an insulin pen when gestatjonal pregnant Diabetes: Insulin's Role Insulin and gestational diabetes to Give a Subcutaneous Injection Annd Giving an Injection in the Arm Using a Syringe Insulin: How to Prepare a Mixed Dose Insulin: How to Prepare a Single Dose. Test procedure — There are a few ways to test for gestational diabetes. The editorial staff at UpToDate would like to acknowledge Donald R Coustan, MD, and Michael F Greene, MD, who contributed to earlier versions of this topic review. The needles are very small, as you only inject a small amount just under your skin. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. GDM has been called a "marker," "stress test," or "window" for future diabetes and CVD; it is not considered causal. |
Insulin and gestational diabetes -
Gestational diabetes usually shows up in the middle of pregnancy. Doctors most often test for it between 24 and 28 weeks of pregnancy. Often gestational diabetes can be managed through eating healthy foods and regular exercise. Sometimes a woman with gestational diabetes must also take insulin. Learn more about Diabetes Self-Management Education and Support Services.
Blood sugar that is not well controlled in a woman with gestational diabetes can lead to problems for the pregnant woman and the baby:. Besides causing discomfort to the woman during the last few months of pregnancy, an extra-large baby can lead to problems during delivery for both the mother and the baby.
The mother might need a C-Section to deliver the baby. The baby can be born with nerve damage due to pressure on the shoulder during delivery. A woman who has diabetes that is not well controlled has a higher chance of needing a C-section to deliver the baby.
When the baby is delivered by a C-section, it takes longer for the woman to recover from childbirth. It is a serious problem that needs to be watched closely and managed by her doctor.
High blood pressure can cause harm to both the woman and her unborn baby. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content. To learn more about Healthwise, visit Healthwise.
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Please turn on JavaScript and try again. Main Content Related to Conditions Diabetes Pregnancy and Childbirth Wise Health Consumer Women's Health. Important Phone Numbers. Top of the page Actionset. Gestational Diabetes: Giving Yourself Insulin Shots. Overview 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. EXERCISE — Adults with diabetes are encouraged to perform 30 to 60 minutes of moderate-intensity aerobic activity 40 to 60 percent maximal oxygen uptake [VO 2 max] on most days of the week at least minutes of moderate-intensity aerobic exercise per week.
A program of moderate exercise is recommended as part of the treatment plan for patients with diabetes as long as they have no medical or obstetric contraindications to this level of physical activity.
Exercise that increases muscle mass, including aerobic, resistance, and circuit training, appears to improve glucose management, primarily from increased tissue sensitivity to insulin.
As a result, exercise can reduce both fasting and postprandial blood glucose concentrations and, in some patients with GDM, the need for insulin may be obviated [ 32 ]. See "Exercise during pregnancy and the postpartum period" and "Exercise guidance in adults with diabetes mellitus".
Glucose meters measure capillary blood glucose, almost all available glucose meters provide plasma equivalent values rather than whole-blood glucose values. Thus, results from most available glucose meters and venous plasma glucose measured in a laboratory should be comparable.
See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus". Intermittent self-monitoring of blood glucose — We suggest that patients self-monitor blood glucose levels [ ]:. Results should be recorded in a glucose log, along with dietary information.
This facilitates recognition of glycemic patterns and helps to interpret results stored in the memory of glucose meters.
We prefer the one-hour postprandial measurement as it corresponds more closely to the maximum insulin peak in patients using rapid-acting insulin analogs. The value of fasting plus postprandial versus preprandial measurement was suggested by a trial that randomly assigned 66 insulin-treated patients with GDM to management according to results of fasting plus postprandial monitoring one hour after meals or according to preprandial-only blood glucose concentrations [ 37 ].
Postprandial monitoring had several benefits as compared with preprandial monitoring: better glycemic management glycated hemoglobin [A1C] value 6.
Can the frequency of self-monitoring be reduced? Multiple daily measurements allow recognition of patients who should begin pharmacologic therapy. In a randomized trial of patients with GDM on nutritional therapy who demonstrated glucose levels in the target range after one week of four times daily glucose testing, those assigned to every other day testing had similar birth weights and frequency of macrosomia as those who continued to test four times daily [ 40 ].
Continuous glucose monitoring — Continuous glucose monitoring CGM allows determination of peak postprandial glucose levels, mean glucose level, episodes of nocturnal hyperglycemia, and percent time in range for a hour period.
We do not routinely use CGM in patients with GDM because of cost and it has not been proven to improve maternal or fetal outcome, but few trials have been performed.
When CGM was compared with frequent self-monitoring of blood glucose in a meta-analysis of two small randomized trials, outcomes were similar for both approaches: cesarean birth risk ratio [RR] 0.
There were no perinatal deaths. Larger trials may clarify whether the favorable trends that were observed are real. Although use of CGM has no clear advantages for most patients, it may be considered in patients who cannot consistently check fingerstick glucose levels and are willing to wear a device.
In addition, some patients choose to use CGM because they want the detailed information about their glucose levels that it provides. Cost may be a barrier to use.
Glucose target — Glucose targets vary among countries and the precise target for optimum maternal, fetal, and newborn outcome is not well-established [ 42 ]. In the United States, the American Diabetes Association ADA and the American College of Obstetricians and Gynecologists ACOG recommend the following upper limits for glucose levels, with insulin therapy initiated if they are exceeded, but acknowledge that these thresholds have been extrapolated from recommendations proposed for pregnant patients with preexisting diabetes [ 24,43 ]:.
These targets are well above the mean glucose values in pregnant people without diabetes described in a literature review of studies of the normal hour glycemic profile of pregnant people [ 44 ]. These levels were derived from measurements on whole blood, plasma, self-monitored capillary glucose measurements, or tissue fluid CGM.
Although glucose levels in whole blood, plasma, and interstitial fluid differ, there was some consistency in the results. Glycated hemoglobin — A1C may be a helpful ancillary test in assessing glycemic management during pregnancy [ 45,46 ].
It is not clear whether or how often it should be monitored in patients with GDM with glucose levels are in the target range. If measured and there is a discrepancy between the A1C and glucose values, then potential causes should be investigated.
High-quality normative data for A1C in each trimester are not available. A1C values tend to be lower in pregnant compared with nonpregnant people [ 47 ] because the average blood glucose concentration is approximately 20 percent lower in pregnant people, and in the first half of pregnancy, there is a rise in red cell mass and a slight increase in red blood cell turnover [ 48,49 ].
Other factors that have been reported to affect A1C values include race although it is not clear whether the higher A1C levels observed in Black persons compared with White persons are due to differences in glucose levels or racial differences in the glycation of hemoglobin [ 50 ] and iron status chronic iron deficiency anemia increases A1C, treatment of iron deficiency anemia with iron lowers A1C.
Sources of variation in A1C levels are discussed in detail separately. See "Measurements of chronic glycemia in diabetes mellitus", section on 'Glycated hemoglobin A1C '. Episodes of physiological ketonemia and ketonuria are not uncommon in pregnancy and can occur with hypocaloric diets [ 53 ].
Studies have reported inconsistent findings regarding a potential association between ketonuria and impaired cognitive outcome in offspring [ ]. Goal — The goal of pharmacotherapy is to manage glucose levels so that the majority are no higher than the upper limit of the target range, without inducing any episodes of hypoglycemia.
Indications for pharmacotherapy. We initiate pharmacotherapy when over 30 percent of the blood glucose values in a week are above target glucose thresholds see 'Glucose target' above. Our general approach is described in the algorithm algorithm 1. Randomized trials regarding when to initiate pharmacotherapy have not been performed.
In a meta-analysis including only two trials, compared with conventional hyperglycemia-based management in patients with a broad GDM severity spectrum, initiation of pharmacotherapy based on ultrasound findings of a large AC increased the percent of patients requiring insulin treatment 34 versus 23 percent, relative risk [RR] 1.
Rates of pregnancy-associated hypertension and cesarean birth were similar in both groups; data on frequency of maternal hypoglycemia were not provided.
Based on these and other findings, it is reasonable for patients with sonographic signs of fetal overgrowth to receive insulin to decrease the risk of large for gestational age and macrosomia despite having less than 30 percent of glucose values above target threshold.
Does early metformin initiation improve glycemic control and reduce need for insulin? Whether initiating metformin at the time of GDM diagnosis regardless of glycemic control improves clinical outcomes compared with usual care was investigated in a randomized trial [ 64 ].
Patients assigned to the metformin group had favorable trends in some secondary outcomes, but the trial was not powered to evaluate these individually:. There was no significant difference in maternal morbidity eg, gestational hypertension or preeclampsia , need for neonatal intensive care unit NICU care, or neonatal hypoglycemia.
Given these mixed findings, we recommend not initiating metformin at the time of GDM diagnosis except in a research setting.
Choice of pharmacotherapy — The pharmacotherapy options in pregnant patients who require pharmacotherapy are insulin and some insulin analogs or selected oral antihyperglycemic agents metformin or glyburide.
We favor insulin because it is effective, easily adjusted based on glucose levels, and safe for the fetus, whereas data are lacking regarding long-term outcomes of offspring exposed to oral antihyperglycemic drugs in utero.
We believe that oral antihyperglycemic agents are a reasonable alternative to insulin for patients in whom pharmacotherapy is indicated but who decline to take, or are unable to comply with, insulin therapy.
Our approach is generally consistent with national and international guidance [ 1,24,43,65,66 ]. Some guidelines consider oral antihyperglycemic drugs an acceptable first-line approach in selected patients, such as those with normal fasting blood glucose levels and modest postprandial hyperglycemia [ ].
See 'Society guideline links' below. Meta-analyses comparing use of oral antihyperglycemic agents with insulin therapy have generally found that both approaches can improve some pregnancy outcomes in patients with GDM or type 2 diabetes [ 61, ].
There is a trend toward more frequent maternal hypoglycemia with use of insulin [ 71 ], and some patients on oral agents need supplemental insulin to achieve and maintain glucose levels in the target range [ 74 ]. However, it is difficult to draw firm conclusions about the optimal approach because of inconsistencies in criteria for GDM, glucose targets, patient adherence to treatment, clinical outcome measures across studies, and lack of long-term safety data [ 71 ].
In randomized trials, compared with insulin, metformin :. In randomized trials, compared with insulin, glyburide :. Dose — The insulin dose required to achieve target glucose levels varies among individuals, but the majority of studies have reported a total dose ranging from 0.
Dose titration to blood glucose levels is based upon frequent self-monitoring. At least four daily glucose measurements are required fasting and one or two hours postprandial with the addition of pre-lunch and pre-dinner measurements as needed to optimize therapy and ensure timely dose increases as insulin requirements increase with pregnancy progression.
The insulin requirement in twin gestations complicated by GDM may double with pregnancy progression. We do not use insulin pumps in patients with GDM because there are no data to suggest that they are necessary or more effective than conventional therapy, and the cost of an insulin pump is not justified over the relatively short duration of a pregnancy.
However, case reports have described successful use in some pregnant people. Pragmatic approach to management of hyperglycemia — Hospitalization is not necessary to initiate insulin therapy; however, if teaching some patients the procedures they need to know is not possible in the outpatient setting, then an inpatient stay to utilize the expertise of the hospital's nursing staff may justify the cost of hospitalization.
One principle we have found useful is to start with the simplest regimen and increase the complexity as needed to address the particular situation. Typically, regardless of body weight, insulin dosing is based on the glucose levels recorded in the patient's blood glucose log.
Because any insulin regimen requires serial dosing adjustments in response to specific fasting or postprandial glucose levels, the starting dose should be considered just that, a starting point.
Weekly glucose log review is recommended so that insulin doses can be adjusted as needed to meet target glucose levels as the pregnancy advances.
Some patients may be diagnosed with diabetes and therapy initiated early in pregnancy prior to 24 to 28 weeks screening ; these patients are managed differently and generally require slightly lower insulin doses since insulin resistance is lower early in pregnancy.
We prefer NPH due to the peak at four to six hours after the dose, which may also aid in covering postprandial lunch excursions. Levemir can also be used but is peakless and would not help as much with the lunch post-meal peak. The upper end of this range is not likely to lead to hypoglycemia in patients with both obesity and GDM unless a meal is omitted after insulin is given.
If both post-breakfast and post-lunch glucose levels are elevated, increasing the morning NPH may be sufficient. The initial dose is 0. Dosing based on glucose levels and weight — An alternative approach to insulin therapy, somewhat more complex and likely most appropriate for individuals whose glucose levels are not well managed with simpler paradigms, is described below:.
A long-acting insulin analog insulin glargine or detemir may be used instead [ 77 ]. See "General principles of insulin therapy in diabetes mellitus". The starting dose is calculated by trimester of pregnancy and body weight: 0. In patients with class II or III obesity, the initial doses of insulin may need to be increased to 1.
Two-thirds of the total daily dose is administered in the morning, with two-thirds of the morning dose given as basal insulin and one-third given as rapid-acting insulin up to 15 minutes before breakfast. One-third of the total daily dose is administered in the evening, with half of this dose given as rapid-acting insulin up to 15 minutes before dinner and the other half given as basal insulin as a nighttime dose usually at bedtime but before dinner is another option on an individualized basis.
A lunchtime dose of rapid-acting insulin may be added if there is continued postprandial lunch hyperglycemia. Hypoglycemia remote from meal or snack time is rare in patients with GDM treated with pharmacotherapy, and it is treated by administering 10 to 20 g of a fast-acting carbohydrate snack immediately.
Since the sugars in milk release more slowly into the bloodstream than pure sugar options, the glucose pattern seen with pure sugars ie, rapid elevation of glucose followed by a rapid decline may be dampened. See "Hypoglycemia in adults with diabetes mellitus", section on 'Reversing hypoglycemia'.
Patients who are feeling better may recheck their blood glucose 15 to 30 minutes after treatment. On the other hand, they may need to give themselves extra insulin to compensate for overtreatment of the symptoms. If low glucose values are encountered more than once at the same time of day, insulin doses are adjusted downward accordingly.
Type of insulin — Use of insulin preparations of low antigenicity may minimize transplacental transfer of insulin antibodies. Human insulin is the least immunogenic of the commercially available preparations. The three rapid-acting insulin analogs lispro, aspart, glulisine are comparable in immunogenicity to human regular insulin , but only lispro and aspart have been investigated in pregnancy and shown to have acceptable safety profiles, minimal transfer across the placenta, and no evidence of teratogenesis.
Neonatal outcomes are similar to those of patients treated with regular insulin [ 61 ]. These two insulin analogs both improve postprandial excursions compared with human regular insulin and are associated with lower risk of delayed postprandial hypoglycemia.
Long-acting insulin analogs insulin glargine , insulin detemir have not been studied as extensively in pregnancy, but data from patients with preexisting pregestational diabetes and studies of placental transfer suggest that both detemir and glargine are safe and effective for use in pregnancy [ ].
See "Pregestational preexisting diabetes mellitus: Antenatal glycemic control", section on 'Type of insulin'. Based on available data, we prefer using human NPH insulin as part of a multiple injection regimen in pregnant people with GDM, especially given the peak at four to six hours after the morning dose, which can help decrease lunch postprandial blood glucose levels without an additional dose of rapid-acting insulin [ 86 ].
The body of data support the safety and effectiveness of NPH in pregnancy, and doses can be adjusted frequently and quickly in response to changing requirements in pregnant patients. If a longer-acting insulin analog is used, we prefer detemir insulin because it can be dosed twice a day, similar to NPH, with the advantage over NPH of more consistent absorption and less variability in absorption among patients.
Insulin detemir is preferred over insulin glargine because it has been studied more extensively in pregnancy and can be dosed twice per day more predictably than glargine, as previously mentioned.
See "General principles of insulin therapy in diabetes mellitus", section on 'Safety'. Oral hypoglycemic agents — Metformin and glyburide are the only noninsulin antihyperglycemic drugs used in pregnancy.
Both oral hypoglycemic agents offer the advantage of significantly decreased cost compared with insulin. Metformin is not associated with hypoglycemia. Choosing metformin versus glyburide — Clinically important pregnancy outcomes are generally similar for metformin and glyburide , with only limited evidence of benefit of one oral agent over the other.
Fetal metformin levels are percent of the maternal level and glyburide levels are 70 percent of the maternal level, which has unknown long-term consequences [ ]. Although metformin and glyburide have not been associated with an increased risk of congenital anatomic anomalies, when either drug is prescribed, patients should be made aware that information regarding the long-term effects of transplacental passage, including possible fetal programming effects, are largely unknown, so caution is warranted until more data are available [ ].
Metformin — A typical dosing regimen is to start metformin extended release XR mg orally once daily with dinner and, if tolerated, increase by mg eg, mg with dinner or mg with dinner plus mg with breakfast based on the degree of glucose elevations. The dose can then be increased by to mg orally per week until reaching the usual effective dose of to mg orally per day divided into two doses maximum daily dose is mg [ 98 ].
An immediate release preparation is also available, but we prefer the XR as it may cause fewer gastrointestinal side effects and fewer daily doses may be needed. The most common side effects of metformin are gastrointestinal, including a metallic taste in the mouth, mild anorexia, nausea, abdominal discomfort, and soft bowel movements or diarrhea.
These symptoms are usually mild, transient, and reversible after dose reduction or discontinuation of the drug. Symptoms can be mitigated by starting at a low dose with slow-dose escalation as needed. In a clinical trial, only 2 percent of study subjects discontinued metformin because of gastrointestinal side effects [ 98 ].
The ADA recommends avoiding metformin in patients with hypertension, preeclampsia, or at risk for intrauterine growth restriction due to the potential for growth restriction or acidosis in the setting of placental insufficiency [ 24,92 ]; however, any clinical impact of this effect has not been observed in human pregnancies.
The American College of Obstetricians and Gynecologists ACOG and the Society for Maternal-Fetal Medicine do not include this caveat in their recommendations. Glyburide — Starting doses of 2. Twice-daily dosing is often necessary to maintain glucose levels in the target range.
One group that investigated glyburide pharmacokinetics in pregnancy suggested pregnant patients take the drug 30 to 60 minutes before a meal, rather than with the meal, to improve efficacy [ 99 ]. In this study, plasma glyburide concentrations in pregnant patients with GDM did not increase until one hour after drug ingestion, peaked at two to three hours, and returned to baseline by 8 to 10 hours.
Thus, the drug took longer to reach peak concentration and was metabolized more rapidly than in nonpregnant females. Maternal hypoglycemia is the most common side effect, and the risk was higher than that in patients with GDM using insulin in a large trial Patients who fail to achieve glycemic control with oral pharmacotherapy — If oral pharmacotherapy alone does not adequately manage glucose levels, supplemental insulin can be prescribed and may be easier for the patient than switching to a multidose insulin only regimen.
In contrast to nonpregnant patients, dual use of oral agents eg, metformin plus glyburide is not recommended in pregnancy because of minimal safety and efficacy data [ 88 ] and concerns about adverse fetal effects since both drugs cross the placenta. See "Pregestational preexisting and gestational diabetes: Intrapartum and postpartum glucose management".
See "Gestational diabetes mellitus: Obstetric issues and management". MATERNAL PROGNOSIS — Most patients with GDM are normoglycemic after giving birth. However, they are at high risk for recurrent GDM and developing prediabetes impaired glucose tolerance or impaired fasting glucose or overt diabetes over the subsequent five years.
Optimum interpregnancy care to minimize these risks has not been well-studied in randomized trials [ ]. Feasibility trials of a web-based lifestyle intervention and a telephone-based intervention reported less postpartum weight retention in patients with GDM assigned to the intervention, suggesting this type of behavioral intervention may have a favorable impact [ , ].
Recurrence — GDM in one pregnancy is a strong predictor of recurrence in a subsequent pregnancy [ ]. In a study including over 65, pregnancies, the frequency of GDM in the second pregnancy among patients with and without previous GDM was 41 and 4 percent, respectively [ ].
Risk factors for recurrence include high birth weight in the index pregnancy, older maternal age, high parity, high prepregnancy weight, and high weight between pregnancies [ , ]. Long-term risk — A history of GDM is predictive of an increased risk of developing type 2 diabetes, metabolic syndrome, cardiovascular disease CVD , and even type 1 diabetes.
These risks appear to be particularly high in patients with both GDM and a hypertensive disorder of pregnancy [ ]. GDM has been called a "marker," "stress test," or "window" for future diabetes and CVD; it is not considered causal.
The RR was 17 within the first five years after delivery and approximately 10 after that. The lifetime maternal risk for diabetes has been estimated to be as high as 50 to 60 percent [ , ]. Waist circumference and body mass index BMI are the strongest anthropometric measures associated with development of type 2 diabetes in patients with GDM [ 61, ], as they are in those without GDM.
Other major risk factors are gestational requirement for insulin and early gestational age at the time of diagnosis ie, less than 24 weeks of gestation [ ].
Additional risk factors for impaired glucose tolerance and overt diabetes later in life include autoantibodies eg, glutamic acid decarboxylase, insulinoma antigen-2 , high-fasting blood glucose concentrations during pregnancy and early postpartum, higher-fasting plasma glucose at diagnosis of GDM and high glucose levels in the GTT, the number of abnormal values on the glucose tolerance test, neonatal hypoglycemia, and GDM in more than one pregnancy [ 61,,,, ].
In one study, an additional pregnancy increased the rate ratio of type 2 diabetes threefold compared with individuals without an additional pregnancy RR 3. The authors hypothesized that repeated episodes of insulin resistance contribute to the decline in beta-cell function that leads to type 2 diabetes in many high-risk individuals.
Parity, large birth weight, and diabetes in a first-degree relative are less correlated with later diabetes. Specific human leukocyte antigen HLA alleles DR3 or DR4 may predispose to the development of type 1 diabetes postpartum, as does the presence of islet-cell autoantibodies [ ] or antibodies against glutamic acid decarboxylase or insulinoma antigen 2.
GDM in lean pregnant people, need for insulin treatment of GDM, diabetic ketoacidosis during pregnancy, and postpartum hyperglycemia also suggest preexisting unrecognized type 1 diabetes or high risk of developing type 1 diabetes [ ]. Although testing for antibodies is not routinely recommended, it is important for clinicians to be aware of this association.
Distinguishing type 1 from type 2 diabetes, and monogenic forms of diabetes eg, maturity-onset diabetes of the young [MODY] from type 1 and type 2 diabetes, is reviewed in detail elsewhere.
See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Differentiating the cause' and "Classification of diabetes mellitus and genetic diabetic syndromes".
In one study of patients with mild GDM ie, normal fasting glucose level on glucose tolerance test [GTT] , approximately one-third developed metabolic syndrome within 5 to 10 years after giving birth [ ]. Even mild glucose impairment defined as an abnormal 50 g one-hour GTT followed by a normal g three-hour GTT appears to identify individuals at increased risk of future development of CVD, usually myocardial infarction or stroke [ ].
In these studies, the increased risk was related to development of type 2 diabetes later in life. More recent data demonstrate that the increased risk of CVD in patients with a prior history of GDM may be independent of the development of type 2 diabetes.
Meta-regression analysis showed that the rates of incident type 2 diabetes across the studies did not affect this risk and when individuals with type 2 diabetes were excluded, GDM was still associated with an increased risk of future CVD RR 1. The increased mortality risk was primarily due to CVD 0.
Testing — Long-term follow-up for development of type 2 diabetes is routinely recommended for individuals with GDM, given their high risk for developing the disorder [ 24,43 ].
GTT — A common approach is to order a GTT to be performed 4 to 12 weeks after giving birth, using the 75 g GTT, as recommended by the American Diabetes Association ADA [ 24 ].
Criteria for diagnosis of diabetes and prediabetes are shown in the tables table 2A-B. Suboptimal adherence has been attributed to not ordering the test, lack of patient follow-up for postpartum care, patient burden associated with a fasting and a two-hour laboratory procedure, and patient difficulty with childcare [ ].
There is increasing evidence that performing the test while the patient is still hospitalized after birth increases adherence to nearly percent and provides reliable results [ , ]. At one year postpartum, the A1C was consistent with impaired glucose metabolism in 35 percent and diabetes in 4 percent of individuals tested.
Fasting glucose — A fasting plasma glucose level is a reasonable alternative to the GTT but does not allow for diagnosis of impaired glucose tolerance. A glycated hemoglobin A1C can be performed in patients in whom obtaining a fasting specimen is especially inconvenient but performs less well for diagnosis of diabetes or prediabetes in postpartum patients because of increased peripartum red cell turnover [ ].
See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Diagnostic tests'. They should have yearly assessment of glycemic status. Approaches to prevention of type 2 diabetes are reviewed in detail separately.
See "Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults", section on 'Prediabetes' and "Prevention of type 2 diabetes mellitus". Higher intensity and longer duration of breastfeeding during the first two years postpartum is associated with a reduced risk of developing type 2 diabetes in observational studies.
See "Gestational diabetes mellitus: Obstetric issues and management", section on 'Breastfeeding'. They should also be given advice regarding contraception and the planning of future pregnancies, especially the importance of good glycemic management prior to conception.
See "Overview of general medical care in nonpregnant adults with diabetes mellitus" and "Pregestational preexisting diabetes: Preconception counseling, evaluation, and management".
See 'Recurrence' above and 'Long-term risk' above. Lifestyle interventions are beneficial for reducing the incidence of type 2 diabetes in persons with prediabetes [ ] and these interventions diet and exercise, achieving a normal body mass index, avoiding smoking and excessive alcohol intake also appear to be beneficial in patients with a history of GDM, whether or not they meet criteria for prediabetes [ ].
The annual incidence of diabetes may be reduced by 30 to 50 percent or more compared with no intervention [ , ]. Pharmacotherapy eg, metformin , pioglitazone may also have a role in preventing future type 2 diabetes. In a multicenter randomized trial, both intensive lifestyle and metformin therapy reduced the incidence of future diabetes by approximately 50 percent compared with placebo in patients with a history of GDM; metformin was much more effective than lifestyle intervention in parous patients with previous GDM [ ].
This topic is discussed in detail separately. See "Prevention of type 2 diabetes mellitus". Reassessment of glycemic status should be undertaken at a minimum of every three years eg, every one to three years [ 24 ].
More frequent assessment may be important in patients who may become pregnant again, since early detection of diabetes is important to preconception and early prenatal care.
More frequent screening every one or two years may also be indicated in patients with other risk factors for diabetes, such as family history of diabetes, obesity, and need for pharmacotherapy during pregnancy.
The best means of follow-up testing has not been defined. The two-hour 75 g oral GTT is the more sensitive test for diagnosis of diabetes and impaired glucose tolerance in most populations, but the fasting plasma glucose is more convenient, specific, and reproducible, and less expensive.
A1C is convenient and the preferred test for patients who have not fasted overnight. See "Screening for type 2 diabetes mellitus", section on 'Screening tests'. See "Overview of primary prevention of cardiovascular disease".
Follow-up of patients not screened for GDM — For patients who did not undergo screening for GDM, but diabetes is suspected postpartum because of newborn outcome eg, hypoglycemia, macrosomia, congenital anomalies , a postpartum GTT may be considered. A normal postpartum GTT excludes the presence of type 1 or type 2 diabetes or prediabetes; it does not exclude the possibility of GDM during pregnancy and the future risks associated with this diagnosis.
Indications for screening and tests used for screening are discussed separately. See "Screening for type 2 diabetes mellitus". SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately.
See "Society guideline links: Diabetes mellitus in pregnancy". These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.
These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon. Here are the patient education articles that are relevant to this topic.
We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest. We suggest glucose self-monitoring before breakfast and at one or at two hours after the beginning of each meal.
See 'Glucose monitoring' above. See 'Can the frequency of self-monitoring be reduced? Moderate exercise also improves glycemic control and should be part of the treatment plan for patients with no medical or obstetric contraindications to this level of physical activity.
See 'Rationale for treatment' above and 'Exercise' above. Calories are generally divided over three meals and two to four snacks per day and are composed of approximately 40 percent carbohydrate, 20 percent protein, and 40 percent fat.
Gestational weight gain recommendations are shown in the table table 1. See 'Medical nutritional therapy' above. Pharmacotherapy can reduce the occurrence of macrosomia and large for gestational age in newborns.
See 'Indications for pharmacotherapy' above. We start with the simplest insulin regimen likely to be effective based on the glucose levels recorded in the patient's blood glucose log and increase the complexity as needed. An alternative approach based on both patient weight and glucose levels is somewhat more complex and likely most appropriate for individuals whose glucose levels are not well managed with simpler paradigms.
See 'Insulin' above. The long-term effects of transplacental passage of noninsulin antihyperglycemic agents are not known. See 'Oral hypoglycemic agents' above. Testing can be performed while the patient is still in the hospital after giving birth.
Otherwise it is performed 4 to 12 weeks postpartum and, if results are normal, at least every three years thereafter. See 'Maternal prognosis' above.
Insulin is a hormone made diabete the pancreas. Gestatlonal Hydration for youth athletes then move ad of the Lean chicken breast and into the cells to be used for energy. Insulin keeps the sugar in your blood under control. These types of insulin can be stored at room temperature for 28 days after opening. Keep unopened bottles in the front of your refrigerator. Insulin is injected into your fatty tissue.Video
Is Gestational Diabetes My Fault? + Gestational Diabetes Meal Plan Gestational diabetes is gestagional type of diabetes that gestqtional during the second or third trimester of dabetes. In Hydration for youth athletes cases women with gestational diabetss did Fat burner pills have diabetes before Insulin and gestational diabetes pregnancy; Isnulin after giving birth, the diabetes usually goes away. During gestational diabetes your body cannot produce enough insulin to handle the effects of a growing baby and changing hormone levels. Insulin is a hormone in your body that helps your body to control the level of glucose sugar in your blood. If your body cannot produce enough insulin, the amount of sugar in your blood will rise.Insulin and gestational diabetes -
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Top of the page Actionset. Gestational Diabetes: Giving Yourself Insulin Shots. Overview 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.
When you use an insulin bottle for the first time, write the date on the bottle. Insulin stored at room temperature will last for about a month. Read and follow all instructions on the label, including how to store the insulin and how long the insulin will last.
Check that a disposable pen's insulin has not expired. This date is usually printed on the pen's label. Prepare the shot Your preparation will depend on whether you are giving one type of insulin or mixing two types of insulin.
To prepare a shot with a single type of insulin, follow the steps for preparing a single dose of insulin. Español Spanish Print. Minus Related Pages. Follow a healthy eating plan to nourish you and your baby.
Preventing Type 2 Diabetes. Diabetes During Pregnancy Diabetes and Women Insulin Resistance Diabetes Articles Infographics. Last Reviewed: December 30, Source: Centers for Disease Control and Prevention.
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Contributor Disclosures. Please read the Disclaimer at the end of this page. Many patients can ddiabetes glucose target Insulin and gestational diabetes with nutritional diabbetes and Boost physical energy exercise Insulin and gestational diabetes, but up to 30 gestatiomal will require pharmacotherapy [ 1 ]. Even patients with mildly elevated glucose levels who do not meet standard criteria for GDM may have more favorable pregnancy outcomes if treated since the relationship between glucose levels and adverse pregnancy outcomes such as macrosomia exists continuously across the spectrum of increasing glucose levels [ ]. Glucose management in patients with GDM is reviewed here.
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