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Gestational Diabetes Mellitus

S. Lindsey Clarke, MD, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Gestational diabetes mellitus (GDM) is the new onset of diabetes in the second half of pregnancy.

    • Maternity care providers should distinguish between GDM and previously unrecognized t...

DIAGNOSIS

HISTORY

  • Usually asymptomatic

  • Ask all pregnant women about risk factors (see above) at first prenatal visit.

PHYSICAL EXAM

  • May be normal

  • Overweight, obesity common

  • Acanthosis nigricans suggests T2D...

TREATMENT

GENERAL MEASURES

  • Treatment benefits both mother and fetus (4)[A].

    • Reduced risk of preeclampsia (NNT = 22)

    • Reduced risks of macrosomia, shoulder dystocia

  • Nutrition therapy for all women with GDM

  • M...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Routine postpartum follow-up unless pharmacotherapy is continued

  • GDM is associated with a nearly 2-fold risk for postpartum depression.

  • Screen for T2DM at 4 to 12 w...

REFERENCES

1
American Diabetes Association. 13. Management of diabetes in pregnancy: Standards of Medical Care in Diabetes2018. Diabetes Care.  2018;41(Suppl 1):S137–S143. [View Abstract on OvidM...

ADDITIONAL READING

SEE ALSO

Diabetes Mellitus, Type 2 

CODES

ICD10

  • O24.429 Gestational diabetes mellitus in childbirth, unsp control

  • O24.420 Gestational diabetes mellitus in childbirth, diet controlled

  • Z86.32 Personal history of gestational diabetes

  • O24.424 G...

CLINICAL PEARLS

  • Screen for undiagnosed T2DM at the first prenatal visit in women with risk factors.

  • Screen for GDM at 24 to 28 weeks of gestation in pregnant women not previously known to have diabetes...

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