gestational dm management

For women diagnosed with gestational diabetes, offer a 75-g 2-hour oral glucose tolerance test (OGTT) to confirm diagnosis if not already done, using thresholds of a fasting plasma glucose level of 5.6 mmol/litre or above or a 2-hour plasma glucose level of 7.8 mmol/litre or above ¹.

Once diagnosed, provide education on the implications for mother and baby, emphasizing that good blood glucose control reduces risks such as macrosomia, trauma during birth, neonatal hypoglycaemia, and perinatal death ¹.

Advise women to manage their blood glucose with diet and exercise initially, including a healthy diet and switching to low glycaemic index foods, and refer to a dietitian ¹.

Encourage regular physical activity, such as walking for 30 minutes after meals ¹.

Self-monitoring of blood glucose should be taught, aiming for target levels of fasting <5.3 mmol/litre and 1-hour post-meal <7.8 mmol/litre, or 2-hours post-meal <6.4 mmol/litre, tailored to individual risk and hypoglycaemia risk ¹.

If blood glucose targets are not met with diet and exercise alone, consider pharmacological treatment, starting with metformin; if contraindicated or unacceptable, offer insulin. If targets are still not achieved, combine insulin with metformin ¹.

Timing of birth should be planned, with delivery ideally no later than 40 weeks plus 6 days, and consider induction or caesarean if indicated ¹.