Gestational diabetes resident survival guide: Difference between revisions
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* The goals for [[glycemic]] control in [[gestational diabetes]] are fasting [[plasma]] [[glucose]] level less than 95mg/dl, one hour and two hour post-meal [[glucose]] level less than 140 and 120mg/dl, respectively<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047 }} </ref><ref name="pmid30559235">{{cite journal| author=American Diabetes Association| title=9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019. | journal=Diabetes Care | year= 2019 | volume= 42 | issue= Suppl 1 | pages= S90-S102 | pmid=30559235 | doi=10.2337/dc19-S009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30559235 }} </ref>. The [[insulin]] regimen can be adjusted according to the [[blood]] [[glucose]] level. In women with elevated early morning fasting [[glucose]] level, a single dose of intermediate-acting [[insulin]] should be administered at night. In females with elevated postprandial [[glucose]] levels, rapid-acting [[insulin]] should be administered half an hour before meals. | * The goals for [[glycemic]] control in [[gestational diabetes]] are fasting [[plasma]] [[glucose]] level less than 95mg/dl, one hour and two hour post-meal [[glucose]] level less than 140 and 120mg/dl, respectively<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047 }} </ref><ref name="pmid30559235">{{cite journal| author=American Diabetes Association| title=9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019. | journal=Diabetes Care | year= 2019 | volume= 42 | issue= Suppl 1 | pages= S90-S102 | pmid=30559235 | doi=10.2337/dc19-S009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30559235 }} </ref>. The [[insulin]] regimen can be adjusted according to the [[blood]] [[glucose]] level. In women with elevated early morning fasting [[glucose]] level, a single dose of intermediate-acting [[insulin]] should be administered at night. In females with elevated postprandial [[glucose]] levels, rapid-acting [[insulin]] should be administered half an hour before meals. | ||
* A single step 75 gram [[oral glucose tolerance test]] can be used to diagnose [[gestational diabetes]]. The [[gestational diabetes]] is diagnosed when [[blood]] [[glucose]] level is equal or greater than 153 mg/dl <ref name="pmid20190296">{{cite journal| author=International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA | display-authors=etal| title=International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. | journal=Diabetes Care | year= 2010 | volume= 33 | issue= 3 | pages= 676-82 | pmid=20190296 | doi=10.2337/dc09-1848 | pmc=2827530 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20190296 }} </ref>. This cut-off criteria increased the [[prevalence]] of [[diabetes]] among [[pregnant]] women in various subpopulations <ref name="pmid21193625">{{cite journal| author=American Diabetes Association| title=Standards of medical care in diabetes--2011. | journal=Diabetes Care | year= 2011 | volume= 34 Suppl 1 | issue= | pages= S11-61 | pmid=21193625 | doi=10.2337/dc11-S011 | pmc=3006050 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21193625 }} </ref>. | * A single step 75 gram [[oral glucose tolerance test]] can be used to diagnose [[gestational diabetes]]. The [[gestational diabetes]] is diagnosed when [[blood]] [[glucose]] level is equal or greater than 153 mg/dl <ref name="pmid20190296">{{cite journal| author=International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA | display-authors=etal| title=International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. | journal=Diabetes Care | year= 2010 | volume= 33 | issue= 3 | pages= 676-82 | pmid=20190296 | doi=10.2337/dc09-1848 | pmc=2827530 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20190296 }} </ref>. This cut-off criteria increased the [[prevalence]] of [[diabetes]] among [[pregnant]] women in various subpopulations <ref name="pmid21193625">{{cite journal| author=American Diabetes Association| title=Standards of medical care in diabetes--2011. | journal=Diabetes Care | year= 2011 | volume= 34 Suppl 1 | issue= | pages= S11-61 | pmid=21193625 | doi=10.2337/dc11-S011 | pmc=3006050 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21193625 }} </ref>. | ||
* An [[antenatal]] [[fetal]] monitoring is recommended in [[gestational diabetes]] [[pregnant]] females starting from 32nd week of [[gestation]]<ref name="pmid29370047">{{cite journal| author=| title=ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. | journal=Obstet Gynecol | year= 2018 | volume= 131 | issue= 2 | pages= e49-e64 | pmid=29370047 | doi=10.1097/AOG.0000000000002501 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370047 }} </ref>. | |||
==Don'ts== | ==Don'ts== | ||
Revision as of 13:04, 25 January 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords:
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
There is no known life-threatening cause for gestational diabetes.
Common Causes
Common causes of gestational diabetes include[1][2]:
- Increased age.
- High Body mass index.
- Low levels of physical activity.
- African American, Hispanic, Asian, and Native American race.
Diagnosis
Shown below is an algorithm summarizing the diagnosis of gestational diabetes according the American College of Obstetricians and Gynecologists guidelines[3][4].
| All pregnant women should be screened for GDM at 24 weeks or more of gestation | |||||||||||||||||
| Two-step screening approach is recommended | |||||||||||||||||
| 50g of oral glucose load is administered to the patient followed by measurement of venous blood glucose level after 1 hour | |||||||||||||||||
| Blood glucose level equal or higher than 190mg/dl or 10.6mmol/l | |||||||||||||||||
| Yes | No | ||||||||||||||||
| 100g of oral glucose load is administered to the patient followed by measured of venous blood glucose level after 3 hours | Second screening test not required | ||||||||||||||||
| Blood glucose level equal or more than 145mg/dl or 8mmol/l | |||||||||||||||||
| Gestational diabetes mellitus diagnosed when there is an abnormal blood glucose level 2 or more times | |||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of gestational diabetes according to the American Diabetes Association guidelines[3][4][5].
| Patients with confirmed gestational diabetes | |||||||||||||||||||||||||||||||||
Lifestyle and dietary modification along with regular monitoring of blood glucose levels.
| |||||||||||||||||||||||||||||||||
| Blood glucose level maintained in the normal range? | |||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||
No need to initiate hypoglycemic medications. | Step- up approach with administration of hypoglycemic drugs. | ||||||||||||||||||||||||||||||||
Do's
- The goals for glycemic control in gestational diabetes are fasting plasma glucose level less than 95mg/dl, one hour and two hour post-meal glucose level less than 140 and 120mg/dl, respectively[3][6]. The insulin regimen can be adjusted according to the blood glucose level. In women with elevated early morning fasting glucose level, a single dose of intermediate-acting insulin should be administered at night. In females with elevated postprandial glucose levels, rapid-acting insulin should be administered half an hour before meals.
- A single step 75 gram oral glucose tolerance test can be used to diagnose gestational diabetes. The gestational diabetes is diagnosed when blood glucose level is equal or greater than 153 mg/dl [7]. This cut-off criteria increased the prevalence of diabetes among pregnant women in various subpopulations [8].
- An antenatal fetal monitoring is recommended in gestational diabetes pregnant females starting from 32nd week of gestation[3].
Don'ts
- Different clinical trials and meta-analysis have demonstrated considerable efficacy of metformin and glyburide for the treatment of gestational diabetes. Metformin has shown more efficacy for glycemic controlling compared to insulin in pregnant females. It does not have immediate adverse effects on fetus and neonates but, its long-term effects on neonates are still unclear[9][10]. Hence glyburide and metformin is only prescribed to pregnant females if they cannot tolerate insulin, obstetrician believes it’s a safer option or due to financial restrictions.
References
- ↑ Snowden JM, Mission JF, Marshall NE, Quigley B, Main E, Gilbert WM; et al. (2016). "The Impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects". Obesity (Silver Spring). 24 (7): 1590–8. doi:10.1002/oby.21532. PMC 4925263. PMID 27222008.
- ↑ Bouthoorn SH, Silva LM, Murray SE, Steegers EA, Jaddoe VW, Moll H; et al. (2015). "Low-educated women have an increased risk of gestational diabetes mellitus: the Generation R Study". Acta Diabetol. 52 (3): 445–52. doi:10.1007/s00592-014-0668-x. PMID 25344768.
- ↑ 3.0 3.1 3.2 3.3 "ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus". Obstet Gynecol. 131 (2): e49–e64. 2018. doi:10.1097/AOG.0000000000002501. PMID 29370047.
- ↑ 4.0 4.1 American Diabetes Association (2017). "13. Management of Diabetes in Pregnancy". Diabetes Care. 40 (Suppl 1): S114–S119. doi:10.2337/dc17-S016. PMID 27979900.
- ↑ "Erratum: Borderud SP, Li Y, Burkhalter JE, Sheffer CE and Ostroff JS. Electronic cigarette use among patients with cancer: Characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer. doi: 10.1002/ cncr.28811". Cancer. 121 (5): 800. 2015. doi:10.1002/cncr.29118. PMID 25855820.
- ↑ American Diabetes Association (2019). "9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019". Diabetes Care. 42 (Suppl 1): S90–S102. doi:10.2337/dc19-S009. PMID 30559235.
- ↑ International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA; et al. (2010). "International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy". Diabetes Care. 33 (3): 676–82. doi:10.2337/dc09-1848. PMC 2827530. PMID 20190296.
- ↑ American Diabetes Association (2011). "Standards of medical care in diabetes--2011". Diabetes Care. 34 Suppl 1: S11–61. doi:10.2337/dc11-S011. PMC 3006050. PMID 21193625.
- ↑ Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J (2018). "Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews". Cochrane Database Syst Rev. 8: CD012327. doi:10.1002/14651858.CD012327.pub2. PMC 6513179 Check
|pmc=value (help). PMID 30103263. - ↑ Butalia S, Gutierrez L, Lodha A, Aitken E, Zakariasen A, Donovan L (2017). "Short- and long-term outcomes of metformin compared with insulin alone in pregnancy: a systematic review and meta-analysis". Diabet Med. 34 (1): 27–36. doi:10.1111/dme.13150. PMID 27150509.