Gestational Diabetes Mellitus (GDM)

Question 1

Early Screening for Women at High Risk

Answer 1

Women at high risk of type 2 diabetes

Screen with A1C (or FPG if A1C unreliable)in first trimester

A1C ≥6.5% or FPG ≥7.0 mmol/L –> treat like
type 2 diabetes

Confirm diagnosis post-partum

Question 2

Why Diagnose and Treat GDM?

Answer 2

Macrosomia
Shoulder dystocia and nerve injury
Neonatal hypoglycemia
Preterm delivery
Hyperbilirubinemia
Macrosomia
Shoulder dystocia and nerve injury
Neonatal hypoglycemia
Preterm delivery
Hyperbilirubinemia

Question 3

Risk factors

Answer 3

 A family history of diabetes, especially in first degree relatives
 Prepregnancy weight ≥110% of ideal body weight or body mass index over 30 kg/m2 or significant weight
gain in early adulthood, between pregnancies, or in early pregnancy
 Age greater than 25 years
 Previous delivery of a baby greater than 4.1 kg
 Personal history of abnormal glucose tolerance
 Member of an ethnic group with higher than the background rate of type 2 diabetes (in most
populations, the background rate is approximately 2 percent)
 Previous unexplained perinatal loss or birth of a malformed child
 Maternal birth weight greater than 4.1 kg or less than 6 pounds 2.7 kg
 Glycosuria at the first prenatal visit
 Polycystic ovary syndrome
 Current use of glucocorticoids
 Essential hypertension or pregnancy-related hypertension

Question 4

Diabetes in Pregnancy: 2 Categories

Answer 4

1. Pregestational diabetes- Pregnancy in
   pre-existing diabetes
   * Type 1 diabetes
   * Type 2 diabetes
2. Gestational diabetes-Diabetes diagnosed in
   pregnancy

Question 5

Recommended Weight Gain based on
Prepregnancy BMI*

Answer 5

BMI< 19.8 kg/m2 28-40 pounds
BMI 19.8-26 kg/m2 25-35 pounds
BMI > 26 kg/m2 15-25 pounds

Question 6

Dietary Modifications

Answer 6

1. 33%–40% carbohydrates, 20% protein, and 40% fat

Question 7

Dietary Modifications~meals

Answer 7

Three small to moderate-sized meals

Question 8

Dietary Modifications

Answer 8

Two to four snacks, one of which should be at bedtime
to prevent the development of ketosis overnight

Question 9

Dietary Modifications-Caloric distribution

Answer 9

Caloric distribution across meals and snacks consists of 10% of total calories at breakfast, 30% at lunch, 30% at dinner, and 30% divided between the snacks.

Question 10

Dietary Modifications-CHO

Answer 10

Complex CHO is preferred instead of simple CHO

Question 11

Glycemic index and GDM

Answer 11

LGI diets reduced the risk of macrosomia
in GDM patients, and LGI diets with added
dietary fiber reduced the risk of
macrosomia further.