Gestational Diabetes

Gestational Diabetes
o D|abetes d|agnosed dur|ng pregnancy that |s
not c|ear|y overt d|abetes
o regnanL women wlLhouL prevlous known uM
o Screen for CuM aL 24-48 weeks' gesLauon
o Cccurs ln 2
nd
& 3
rd
LrlmesLer because lncrease
ln lnsulln-anLagonlsL hormone levels and
lnsulln reslsLance LhaL occurs aL LhaL ume
GDM Risk
o CbeslLy (8Ml > 30)
o ersonal hlsLory of CuM
o Clycosurla and/or hyperLenslon
o 1
sL
degree relauve wlLh dlabeLes
o rlor poor obsLeLrlcal ouLcome
o Member of hlgh rlsk eLhnlc group
GDM & T2DM Risk: Mom
o CuM reporLed raLes had been 2-10 of uS
pregnancles
o new dlagnosuc crlLerla ln us - 18 pregnancles
o lmmedlaLe posL-parLum: 3-10 of CuM - 1ype 2
o lf CuM, 33-60 chance - 1ype 2 ln 10-20 years

GDM & Diabetes Risk: Baby
Plgh blood
glucose levels
ln moLher
uellver exLra
glucose Lo
baby
8aby galns
excess welghL
Diagnosing GDM
o revlous denluon: any degree of glucose
lnLolerance wlLh onseL or rsL recognluon
durlng pregnancy
o ^ undlagnosed dlabeLes - now dened as any
ndlng of dlabeLes aL rsL prenaLal vlslL
o Use 7S-g 2-hr CG11 of >200 mg]dL (11.1
mmo|]L) to d|agnose
GDM Diet Basics
o 8ase and ad[usL foods on posLprandlal 8S
o 8ecommendauons for all pregnanL women
apply
o ConLrol of carbohydraLe ls key
o Well-balanced lnLake of mlcronuLrlenLs
o Spread food lnLo 3 small meals and 2-4 snacks
Cal ories
o ually mlnlmum of 1,700-1,800 kcal has been
shown Lo prevenL keLosls and prevenL
maLernal welghL galn
o WelghL loss durlng pregnancy noL
recommended buL modesL energy resLrlcuon
(70 of u8l for pregnanL women) may help
slow welghL galn
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Carbohydrate
o Mlnlmum 173 g/day
o Plgher clrculaung hormones durlng early mornlng
hours, mosL dlmculL 8C ls pre-breakfasL
o Consensus: resLrlcL carb aL breakfasL Lo 13-30 g
o Lvenlng snack needed Lo prevenL acceleraLed
keLosls overnlghL
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Carbohydrate
Mea| Carbohydrate (g)
8reakfasL 13-30
Snack 13-30
Lunch 43-60
Snack 13-30
ulnner 43-60
Snack 13-30
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Macronutrients for GDM
Carbohydrate Mlnlmum 173 grams/day
rote|n
1.1 g/kg welghL per day
AbouL 23 exLra grams
Iat 20-33 of calorles per day
Physical Activity for GDM
o 30 mlnuLes of physlcal acuvlLy per day aL leasL
3 days per week
@"';#A B.-# C'.1. D/ E.$$."#.
Bl ood Sugar Goal s
mg]dL mmo|]L
reprand|a| < 93 < 3.3
1-h postprand|a| < 140 < 7.8 or
2-h postprand|a| < 120 < 6.7
*%'3#+#- F'$#/ B'(4'$G =>H= 8.1 IJ (. D4::1#"#(+ H DHH9DKI/
Medication & Insul in Therapy
o lnsulln, glyburlde and now meuormln
recommended lf opumal 8C levels are noL
malnLalned wlLh medlcal nuLrluon Lherapy
o laclllLaLe accepLance of medlcauons and lnsulln
when
2 or more 8S > LargeL wlLhln 1 week
lf unable Lo achleve 8S goals wlLhouL keLones,
adequaLe welghL galn and normal nuLrluon
!&'2#"G .L M4+$%,.( '(2 *%#+#,&-< M4+$%,.( F'$# 6'(4'1< =>H=
GDM Fol l ow-Up
o MosL reLurn Lo normal glucose Lolerance
shorLly aer dellvery
o 6-12 weeks posLparLum, 73g CC11 or A1C LesL
should be done, use nonpregnanL dx crlLerla
o lf LesL normal - repeaL ln 1 year, every year
aer
For More Infor mation
o ubMed PealLh CesLauonal ulabeLes:
hup://www.ncbl.nlm.nlh.gov/pubmedhealLh/
MP0001898/
o Amerlcan ulabeLes Assoclauon - CesLauonal ulabeLes:
hup://www.dlabeLes.org/dlabeLes-baslcs/gesLauonal/
o uCSl auenL Lducauon - ulabeLes ln regnancy:
hup://www.ucsmealLh.org/educauon/
dlabeLes_ln_pregnancy/lndex.hLml