Gestational diabetes mellitus

Explain to women that GDM may be associated with delayed lactogenesis. Therefore early specialist lactation support may be required.[113]Matias SL, Dewey KG, Quesenberry CP Jr, et al. Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Am J Clin Nutr. 2014 Jan;99(1):115-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862450 http://www.ncbi.nlm.nih.gov/pubmed/24196401?tool=bestpractice.com

Explain the risks of recurrence in future pregnancies, and offer women who have a history of GDM diabetes testing when planning future pregnancies.[4]National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication]. https://www.nice.org.uk/guidance/ng3

Support women who have a history of GDM to make lifestyle changes to reduce the risk of type 2 diabetes and cardiovascular disease: NIDDK: preventing type 2 diabetes Opens in new window NIDDK: definition and facts of gestational diabetes Opens in new window IDF: gestational diabetes Opens in new window GDM increases the risk of type 2 diabetes and cardiovascular disease and long-term follow-up is needed. This should include an annual assessment of HbA1c, lipid profile, blood pressure, weight management, and smoking cessation, as well as encouragement to adopt other healthy lifestyle measures including diet changes and regular exercise. 

Ensure effective contraception is discussed with any woman who has a history of GDM and encourage her to seek medical evaluation before trying for another pregnancy. In addition, remind her of the symptoms of hyperglycaemia and the importance of reporting it if it occurs.[4]National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication]. https://www.nice.org.uk/guidance/ng3

• Explain to women who have had previous GDM but who have not yet developed type 2 diabetes about the risks of recurrence of GDM in future pregnancies and offer them testing for type 2 diabetes with an HbA1c prior to planning future pregnancies.[4]National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. Dec 2020 [internet publication]. https://www.nice.org.uk/guidance/ng3

• All women planning pregnancy should be given advice on folic acid, stopping smoking, and achieving a healthy weight, and should have a medication review prior to conceiving, to increase the chances of a successful pregnancy outcome.