How should you manage gestational diabetes

Management of gestational diabetes in pregnant women should begin with early diagnosis using a 75-g 2-hour oral glucose tolerance test (OGTT) in women with risk factors or previous gestational diabetes NICE NG3. On diagnosis, women must be educated on the implications of gestational diabetes for themselves and their babies, emphasizing that good blood glucose control reduces risks such as fetal macrosomia, birth trauma, neonatal hypoglycaemia, and perinatal death NICE NG3.

The initial management should focus on lifestyle modifications, specifically tailored advice on healthy eating low in high glycaemic index foods, regular physical activity such as walking for 30 minutes after meals, and referral to a dietitian NICE NG3 Sánchez-García et al. 2023. Self-monitoring of blood glucose should be taught, targeting fasting plasma glucose below 5.3 mmol/l and 1-hour postprandial glucose below 7.8 mmol/l without causing hypoglycaemia NICE NG3.

If blood glucose targets are not achieved within 1 to 2 weeks of diet and exercise changes, pharmacological treatment should be initiated, with metformin as the first-line option unless contraindicated or unacceptable to the woman, in which case insulin therapy is recommended NICE NG3 Allen 2003. If metformin alone is insufficient, insulin should be added to meet glycaemic targets NICE NG3. Women with more severe hyperglycaemia at diagnosis (fasting glucose ≥7.0 mmol/l) or with complications such as macrosomia should start insulin, with or without metformin, alongside lifestyle changes immediately NICE NG3.

Blood glucose monitoring frequency depends on treatment: women managed by diet and exercise or oral agents should monitor fasting and 1-hour post-meal glucose daily; those on multiple daily insulin injections require more frequent monitoring including pre-meal and bedtime checks NICE NG3. Hypoglycaemia risks should be addressed by advising availability of fast-acting glucose sources and education on management NICE NG3.

Antenatal care includes timely ultrasound scans for fetal growth and wellbeing monitoring, typically starting at 28 weeks, and discussion on timing and mode of delivery, advising birth by 40 weeks plus 6 days for uncomplicated gestational diabetes, with induction or cesarean offered if delivery is not spontaneous NICE NG3.

Recent nutritional research supports the importance of individualized dietary interventions focusing on glycaemic index and quality of carbohydrates to improve maternal glucose control and reduce fetal complications, aligning with guideline recommendations for dietitian referral and healthy diet advice Sánchez-García et al. 2023. This evidence strengthens the role of medical nutrition therapy as a cornerstone of management alongside pharmacotherapy when necessary.