Complications
Maternal hypertension frequently complicates GDM. Routine assessments of blood pressure and urinary protein are warranted.[21] Pre-eclampsia is also increased in GDM, and risk is related to increasing maternal glucose levels.
Treatment for GDM may reduce the risk for pre-eclampsia and hypertensive disorders in pregnancy.[57][56]
Non-elective caesarean section rates are increased in GDM.[107] Fetal macrosomia only partially explains this increased rate.[21] Knowledge of a patient's GDM may influence the decision of delivery route and increase caesarean section rates because of concerns about fetal macrosomia and other fetal complications.
Risk increases with poor maternal glucose control.[56]
Risk of hypoglycaemia increases with degree of maternal hyperglycaemia, especially during labour. A case-control comparison found hypoglycaemia in 5% of neonates delivered to mothers with GDM versus <1% of controls.[22] Intrapartum glycaemic monitoring and control are warranted.
Prevalence is increased three- to fourfold and complicates 10% to 20% of pregnancies with diabetes involvement.[22]
GDM increases risk of hyperbilirubinaemia to approximately 17%, a rate about double that in non-diabetic controls.[22]
Hypocalcaemia was documented in almost 5% of pregnancies complicated by GDM, a rate about double that of controls without diabetes.[22]
Pregnancies of women with fasting hyperglycaemia and poor glycaemic control are at greater risk.[108] Risk is not likely to be increased in women with GDM that is well controlled with diet alone. Risk of serious perinatal complications, including fetal demise, was reduced by treatment in a randomised trial.[109]
Hypoglycaemia frequently complicates the therapy of insulin-treated patients and is usually of mild severity.[103]
Advise any woman who is taking insulin about the risks of hypoglycaemia and impaired awareness of hypoglycaemia during pregnancy.[4] Pregnant women taking insulin should always have a fast-acting form of glucose available (e.g., dextrose tablets or glucose-containing drinks).
GDM recurs in 30% to 84% of subsequent pregnancies.[17] The wide range in recurrence rate is influenced by the variability of formal retesting in subsequent pregnancies.
The majority of women with GDM eventually develop type 2 diabetes, but diabetes can be delayed through lifestyle modification or metformin.[100][101][102][104][105] Women with prior GDM should be counselled about healthy lifestyle measures. Patients with a history of GDM require close monitoring for the development of type 2 diabetes.[3][106] For example, the American Diabetes Association recommends screening women with a history of GDM for prediabetes or type 2 diabetes every 1 to 3 years.[3]
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