Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.
The following is an outline of practice guidelines for management of gestational diabetes mellitus. A detailed management plan and accompanying DecisionPaths can be found in the original guidelines:
Screening
Screen between the 24th and 28th gestational weeks; with any risk factor, consider screening at first prenatal visit.
Screen with 50-gram glucose challenge test: 1-hour plasma glucose >140 mg/dL positive; >120 mg/dL suspected.
Risk Factors
- Body mass index >25 kg/m2 (especially waist-to-hip ratio >1)
- Family history of type 2 diabetes (especially first-degree relatives)
- Age older than 25 years
- Multiparity
- Previous gestational diabetes: Macrosomic or large-for-gestational age infant (e.g., >9 lbs. or 4000 grams)
- Previous impaired fasting glucose with fasting plasma glucose 110 to 125 mg/dL
- Previous impaired glucose tolerance with oral glucose tolerance test 2-hour glucose value 140 to 199 mg/dL
- American Indian or Alaska Native, African American, Asian, Hispanic, Pacific Islander
Diagnosis
Plasma Glucose
100 gram oral glucose tolerance test after 8 to 10 hours overnight fast:
Fasting >95 mg/dL, 1 hour >180 mg/dL, 2 hour >155 mg/dL, 3 hour >140 mg/dL; two abnormal values required for diagnosis; if one abnormal, consider self-monitored blood glucose for 7 days; if average fasting blood glucose >95 mg/dL or average 2-hour post-meal >120 mg/dL, re-evaluate for gestational diabetes mellitus. See "Gestational: Master DecisionPath" in the full-text guideline.
Symptoms
Usually none. Rarely, increased urination, thirst, and appetite; nocturia; weight loss
Urine Ketones
Usually negative; positive can indicate starvation ketosis
Treatment Options
Medical nutrition therapy; Glyburide Stage; insulin Stages 3, 4
Targets
Self-Monitored Blood Glucose
- All values within target range
- Pre-meal and bedtime: 60 to 95 mg/dL
- Post-meal: <120 mg/dL 2 hours after start of meal; <140 mg/dL 1 hour after start of meal
Hemoglobin A1c(HbA1c)
May be used to evaluate prior hyperglycemia, but is not used in gestational diabetes management; should be within normal range
Urine Ketones (Fasting)
Negative
Monitoring
Self-Monitored Blood Glucose
6 to 7 times/day; before and 1 to 2 hours after start of meals, and at bedtime; 4 times/day minimum; fasting and 1 to 2 hours after start of meals
Method
Meter with memory and log book
Urine Ketones (Fasting)
Every morning until negative for 7 days, then every other morning
Follow-Up
Pre-natal
Phone 1 to 2 times a week to review self-monitored blood glucose data; office visit every 2 weeks up to 36 weeks, then weekly; self-monitored blood glucose data (download and check meter); frequency of hypoglycemia; weight or body mass index; medications; blood pressure; medical nutrition therapy; exercise
Fetal Monitoring
Kick counts at 28 weeks; non-stress test at 34 weeks and until end of pregnancy
After Delivery
In hospital: Check fasting blood glucose and 2 hours after breakfast each day.
After discharge: Check fasting blood glucose and blood glucose 2 hours after breakfast 1 day/week until first postpartum visit. If fasting blood glucose >120 mg/dL, and/or post-prandial blood glucose >160 mg/dL, evaluate for diabetes immediately.
6 weeks: Nutrition education if needed
3 to 6 months: Evaluate for diabetes and yearly thereafter
