Gestational diabetes mellitus is defined as glucose intolerance of variable degree with onset or first recognition during pregnancy. A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors.
Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission.
The goal of dietary therapy is to avoid single large meals and foods with a large percentage of simple carbohydrates. A total of 6 feedings per day is preferred, with 3 major meals and 3 snacks to limit the amount of energy intake presented to the bloodstream at any interval. The diet should include foods with complex carbohydrates and cellulose, such as whole grain breads and legumes.
In the first trimester, patients should have an ultrasonogram assessment (including measurement of crown-rump length) for pregnancy dating and viability. Consider nuchal translucency if the fetus is at high risk for cardiac defects (eg, because of high maternal glycohemoglobin)
In the second trimester, perform a detailed anatomy ultrasonogram at 18-20 weeks, and a fetal echocardiogram if the maternal glycohemoglobin value was elevated in the first trimester.
In patients with preexisting diabetes, nutritional and metabolic intervention must be initiated well before pregnancy begins, because birth defects occur during the critical 3-6 weeks after conception.
Insulin remains the standard medication for treatment of diabetes during pregnancy, but the oral agents glyburide and metformin are increasingly used.
Second-trimester testing for women with diabetes includes a repeat spot urine protein-to-creatinine study in women with elevated value in first trimester, a repeat HbA1C, and capillary blood sugar levels 4-7 times daily.
If preeclampsia is suggested, order the following tests: