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Update on Gestational Diabetes

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Obesity and Diabetes

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Abstract

Gestational diabetes mellitus (GDM) has become increasingly prevalent in the United States, and its impact on adverse maternal and neonatal outcomes necessitates proper screening, management, and follow up. Although there is a lack of consensus on screening methods for GDM, the American College of Obstetrics and Gynecology (ACOG) recommends the two-step approach between 24 and 28 weeks. In contrast, the International Association of Diabetes and Pregnancy Study Group (IADPSG) recommends a one-step approach. Once the diagnosis of GDM has been made, management may consist of nutritional therapy, alone, or in combination with pharmacologic interventions such as insulin, metformin, or less often, glyburide. Close management is warranted in order to avoid adverse maternal and neonatal outcomes, both during delivery and later in life to both mother and infant.

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References

  • American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics (2016) Practice Bulletin No. 173: fetal macrosomia. Obstet Gynecol 128(5):e195–e209

    Google Scholar 

  • American Diabetes Association (2008) Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31(Supplement 1):S61–S78

    Google Scholar 

  • American Diabetes Association (2018a) Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes Care 42(Supplement 1):S13–S28

    Google Scholar 

  • American Diabetes Association (2018b) 14. Management of diabetes in pregnancy: standards of medical care in diabetes—2019. Diabetes Care 42(Supplement 1):S165–S172

    Google Scholar 

  • Anna V, Ploeg HPVD, Cheung NW, Huxley RR, Bauman AE (2008) Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care 31(12):2288–2293

    PubMed  PubMed Central  Google Scholar 

  • Balsells M, Garcia-Patterson A, Sola I, Roque M, Gich I, Corcoy R (2015) Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ 350:h102

    PubMed  PubMed Central  Google Scholar 

  • Baptiste-Roberts K, Barone BB, Gary TL et al (2009) Risk factors for type 2 diabetes among women with gestational diabetes: a systematic review. Am J Med 122(3):207-214.e4

    PubMed  PubMed Central  Google Scholar 

  • Bennett SN, Tita A, Owen J, Biggio JR, Harper LM (2015) Assessing Whiteʼs classification of pregestational diabetes in a contemporary diabetic population. Obstet Gynecol 125(5):1217–1223

    PubMed  PubMed Central  Google Scholar 

  • Berkowitz GS, Lapinski RH, Wein R, Lee D (1992) Race/ethnicity and other risk factors for gestational diabetes. Am J Epidemiol 135(9):965–973

    CAS  PubMed  Google Scholar 

  • Brown J, Martis R, Hughes B, Rowan J, Crowther CA (2017) Oral anti-diabetic pharmacological therapies for the treatment of women with gestational diabetes. Cochrane Database Syst Rev 1:CD011967

    PubMed  Google Scholar 

  • Caissutti C, Khalifeh A, Saccone G, Berghella V (2017) Are women positive for the one step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes? Acta Obstet Gynecol Scand 97(2):122–134

    PubMed  Google Scholar 

  • Castillo WC, Boggess K, Stürmer T, Brookhart MA, Benjamin DK, Funk MJ (2014) Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000–2011. Obstet Gynecol 123(6):1177–1184

    PubMed Central  Google Scholar 

  • Cheung NW, Moses RG (2018) Gestational diabetes mellitus: is it time to reconsider the diagnostic criteria? Diabetes Care 41(7):1337–1338

    PubMed  Google Scholar 

  • Chu SY, Callaghan WM, Kim SY et al (2007) Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 30(8):2070–2076

    PubMed  Google Scholar 

  • Dabelea D, Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, Mcduffie RS (2005) Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser permanente of colorado GDM screening program. Diabetes Care 28(3):579–584

    PubMed  Google Scholar 

  • Deputy NP, Kim SY, Conrey EJ, Bullard KM (2018) Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth—United States, 2012–2016. MMWR Morb Mortal Wkly Rep 67(43):1201–1207

    PubMed  PubMed Central  Google Scholar 

  • Feig DS, Zinman B, Wang X, Hux JE (2008) Risk of development of diabetes mellitus after diagnosis of gestational diabetes. Obstet Gynecol Surv 63(12):759–761

    Google Scholar 

  • Ferrara A (2007) Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 30(Supplement 2):S141–S146

    PubMed  Google Scholar 

  • Final Recommendation Statement [Internet] (2019) Gestational Diabetes Mellitus, Screening—US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/gestational-diabetes-mellitus-screening. Accessed 18 Nov 2019

  • Gestational Diabetes Mellitus (2018) ACOG Practice Bulletin No. 190. American College of Obstetricians and Gynecologists. Obstet Gynecol 131(2):e49–e64

    Google Scholar 

  • Getahun D, Nath C, Ananth CV, Chavez MR, Smulian JC (2008) Gestational diabetes in the United States: temporal trends 1989 through 2004. Am J Obstet Gynecol 198(5):525.e1-5

    PubMed  Google Scholar 

  • Gilmartin A, Ural SH, Repke JT (2008) Gestational diabetes mellitus. Rev Obstet Gynecol 1(3):129–134

    PubMed  Google Scholar 

  • Gui J, Liu Q, Feng L (2013) Metformin vs insulin in the management of gestational diabetes: a meta-analysis. PLoS One 8(5):e64585

    CAS  PubMed  PubMed Central  Google Scholar 

  • Hamel MS, Kanno LM, Has P, Beninati MJ, Rouse DJ, Werner EF (2019) Intrapartum glucose management in women with gestational diabetes mellitus. Obstet Gynecol 133(6):1171–1177

    PubMed  Google Scholar 

  • HAPO Study Cooperative Research Group (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358(19):1991–2002

    Google Scholar 

  • Hare JW, White P (1980) Gestational diabetes and the White classification. Diabetes Care 3:394

    Google Scholar 

  • Hillier T, Pedula K, Vesco K et al (2009) Excess gestational weight gain: modifying fetal macrosomia risk associated with maternal glucose. Obstet Anesth Dig 29(4):189

    Google Scholar 

  • Hod M, Kapur A, Sacks DA et al (2015) The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynecol Obstet 131:S173–S211

    Google Scholar 

  • Jarvela IY, Juutinen J, Koskela P et al (2006) Gestational diabetes identifies women at risk for permanent type 1 and type 2 diabetes in fertile age: predictive role of autoantibodies. Diabetes Care 29(3):607–612

    CAS  PubMed  Google Scholar 

  • Joffe GM, Esterlitz JR, Levine RJ et al (1998) The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Am J Obstet Gynecol 179(4):1032–1037

    CAS  PubMed  Google Scholar 

  • Johnstone FD, Prescott RJ, Steel JM, Mao JH, Chambers S, Muir N (1996) Clinical and ultrasound prediction of macrosomia in diabetic pregnancy. BJOG: Int J Obstet Gynaecol 103(8):747–754

    CAS  Google Scholar 

  • Kessous R, Shoham-Vardi I, Pariente G, Sheiner E (2013) 292: The association between gestational diabetes mellitus and long term maternal cardiovascular morbidity in a follow-up period of more than a decade. Am J Obstet Gynecol 208(1):S132

    Google Scholar 

  • Kitzmiller JL, Dang-Kilduff L, Taslimi MM (2007) Gestational diabetes after delivery: short-term management and long-term risks. Diabetes Care 30(Supplement 2):S225–S235

    CAS  PubMed  Google Scholar 

  • Kjos SL, Leung A, Henry OA, Victor MR, Paul RH, Medearis AL (1995) Antepartum surveillance in diabetic pregnancies: predictors of fetal distress in labor. Am J Obstet Gynecol 173(5):1532–1539

    CAS  PubMed  Google Scholar 

  • Kwik M, Seeho S, Smith C, Mcelduff A, Morris J (2007) Outcomes of pregnancies affected by impaired glucose tolerance. Diabetes Res Clin Pract 77(2):263–268

    CAS  PubMed  Google Scholar 

  • Lazer S, Biale Y, Mazor M, Lewenthal H, Insler V (1986) Complications associated with the macrosomic fetus. J Reprod Med 31(6):501–505

    CAS  PubMed  Google Scholar 

  • Little SE, Edlow AG, Thomas AM, Smith NA (2012) Estimated fetal weight by ultrasound: a modifiable risk factor for cesarean delivery? Am J Obstet Gynecol 207(4):309.e1-6

    PubMed  Google Scholar 

  • Lowe WL, Scholtens DM, Lowe LP et al (2018) Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity. JAMA 320(10):1005

    CAS  PubMed  PubMed Central  Google Scholar 

  • Lurie S, Insler V, Hagay Z (1996) Induction of labor at 38 to 39 weeks of gestation reduces the incidence of shoulder dystocia in gestational diabetic patients class A2. Am J Perinatol 13(05):293–296

    CAS  PubMed  Google Scholar 

  • Mackin ST, Nelson SM, Wild SH, Colhoun HM, Wood R, Lindsay RS (2019) Factors associated with stillbirth in women with diabetes. Diabetologia 62(10):1938–1947

    CAS  PubMed  PubMed Central  Google Scholar 

  • Mcintyre HD, Jensen DM, Jensen RC et al (2018) Gestational diabetes mellitus: does one size fit all? a challenge to uniform worldwide diagnostic thresholds. Diabetes Care 41(7):1339–1342

    PubMed  Google Scholar 

  • Metzger BE (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33(3):676–682

    PubMed  Google Scholar 

  • Metzger BE, Buchanan TA, Coustan DR et al (2007) Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care 30(Supplement 2):S251–S260

    CAS  PubMed  Google Scholar 

  • Middleton P, Shepherd E, Crowther CA (2018) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 5:CD004945

    PubMed  Google Scholar 

  • Mitanchez D (2010) Foetal and neonatal complications in gestational diabetes: perinatal mortality, congenital malformations, macrosomia, shoulder dystocia, birth injuries, neonatal complications. Diabetes Metab 36(6):617–627

    CAS  PubMed  Google Scholar 

  • Moyer VA, U.S. Preventive Services Task Force (2014) Screening for Gestational Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 160(6):414–420

    PubMed  Google Scholar 

  • Nicholson WK, Wilson LM, Witkop CT et al (2008) Therapeutic management, delivery, and postpartum risk assessment and screening in gestational diabetes. Evid Rep Technol Assessment 162:1–96

    Google Scholar 

  • Nold JL, Georgieff MK (2004) Infants of diabetic mothers. Pediatr Clin N Am 51(3):619–637

    Google Scholar 

  • O’Sullivan JB, Mahan CM (1964) Criteria for the oral glucose tolerance test in pregnancy. Diabetes 13:278

    PubMed  Google Scholar 

  • Practice Bulletin No. 173 Summary (2016) Fetal Macrosomia. Obstet Gynecol 128(5):1191–1192

    Google Scholar 

  • Ratner RE, Christophi CA, Metzger BE et al (2008) Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metabol 93(12):4774–4779

    CAS  Google Scholar 

  • Rø TB, Ludvigsen HV, Carlsen SM, Vanky E (2012) Growth, body composition and metabolic profile of 8-year-old children exposed to metforminin utero. Scand J Clin Lab Invest 72(7):570–575

    PubMed  Google Scholar 

  • Roeckner JT, Sanchez-Ramos L, Jijon-Knupp R, Kaunitz AM (2016) Single abnormal value on 3-hour oral glucose tolerance test during pregnancy is associated with adverse maternal and neonatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 215(3):287–297

    PubMed  Google Scholar 

  • Rouse DJ, Owen J, Goldenberg RL, Cliver SP (1997) The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound. Obstet Gynecol Surv 52(6):337–339

    Google Scholar 

  • Rowan JA, Rush EC, Plank LD et al (2018) Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition and metabolic outcomes at 7–9 years of age. BMJ Open Diabetes Res Care 6(1):e000456

    PubMed  PubMed Central  Google Scholar 

  • Rumbold AR, Crowther CA (2002) Womens experiences of being screened for gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 42(2):131–137

    PubMed  Google Scholar 

  • Ryan EA, Al-Agha R (2013) Glucose control during labor and delivery. Curr Diab Rep 14(1):450

    Google Scholar 

  • Saccone G, Khalifeh A, Al-Kouatly HB, Sendek K, Berghella V (2020) Screening for gestational diabetes mellitus: one step versus two step approach. A meta-analysis of randomized trials. J Matern Fetal Neonatal Med 33(9):1616–1624

    PubMed  Google Scholar 

  • Sacks DA, Metzger BE (2013) Classification of diabetes in pregnancy. Obstet Gynecol 121:345–348

    PubMed  Google Scholar 

  • Scifres CM, Feghali M, Dumont T et al (2015) Large-for-gestational-age ultrasound diagnosis and risk for cesarean delivery in women with gestational diabetes mellitus. Obstet Gynecol 126(5):978–986

    PubMed  Google Scholar 

  • SMFM Publications Committee (2018) SMFM statement: pharmacological treatment of gestational diabetes. Am J Obstet Gynecol 218(5):1

    Google Scholar 

  • Solomon CG (1997) A prospective study of pregravid determinants of gestational diabetes mellitus. JAMA 278(13):1078–1083

    CAS  PubMed  Google Scholar 

  • Turok DK, Ratcliffe SD, Baxley EG (2003) Management of gestational diabetes mellitus. Am Fam Physician 68(9):1767–1773

    PubMed  Google Scholar 

  • Valent A, Caughey A (2016) When to deliver women with diabetes in pregnancy? Am J Perinatol 33(13):1250–1254

    PubMed  Google Scholar 

  • Vandorsten JP, Dodson WC, Espeland MA, Grobman WA, Guise JM, Mercer BM et al (2013) NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 29:1–31. (Level III)

    PubMed  Google Scholar 

  • Vanky E, Zahlsen K, Spigset O, Carlsen S (2005) Placental passage of metformin in women with polycystic ovary syndrome. Fertil Steril 83(5):1575–1578

    PubMed  Google Scholar 

  • Varner MW, Rice MM, Landon MB et al (2017) Pregnancies after the diagnosis of mild gestational diabetes mellitus and risk of cardiometabolic disorders. Obstet Gynecol 129(2):273–280

    PubMed  PubMed Central  Google Scholar 

  • Veciana MD, Major CA, Morgan MA et al (1996) Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. Obstet Gynecol Surv 51(4):207–208

    Google Scholar 

  • Werner E, Romano M, Rouse D (2018) 992: The association between gestational diabetes mellitus and neonatal respiratory morbidity. Am J Obstet Gynecol 218(1):S586

    Google Scholar 

  • Wouldes TA, Battin M, Coat S, Rush EC, Hague WM, Rowan JA (2017) Neurodevelopmental outcome at 2 years in offspring of women randomised to metformin or insulin treatment for gestational diabetes. Obstet Gynecol Surv 72(3):149–151

    Google Scholar 

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Authors and Affiliations

  1. Maternal Fetal Medicine, Dignity Health Perinatal Center, Ventura, CA, USA

    Megan Jones

  2. The Ohio State University College of Medicine, Columbus, OH, USA

    Allison Akers

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  1. Megan Jones
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Correspondence to Megan Jones .

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Editors and Affiliations

  1. Hospital das Clinicas, Sao Paulo University Medical School, Sao Paulo, Brazil

    Joel Faintuch

  2. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Salomão Faintuch

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Jones, M., Akers, A. (2020). Update on Gestational Diabetes. In: Faintuch, J., Faintuch, S. (eds) Obesity and Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-53370-0_36

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