Monitoring

See Management approach for recommendations on maternal and fetal monitoring during pregnancy and the intrapartum period.

A diagnosis of GDM mandates follow-up assessments of glycemia postpartum; but unfortunately rates of postpartum screening for diabetes mellitus in women with a history of GDM are low, with fewer than half of women receiving screening.[1][48]​​[51]​​​​​​​[139] Studies have suggested that there are multiple reasons for this, such as transportation, lack of childcare, limited coverage for medical care, and lack of understanding of the risks of diabetes mellitus.[48]​​

Women should be screened with a 75-g oral glucose tolerance test (OGTT), using nonpregnant OGTT criteria, either in the immediate postpartum period (during delivery hospitalization) or at 4-12 weeks postpartum. The OGTT is preferred as a more sensitive test than fasting plasma glucose or HbA1c.[1][48]​​​​ However, given the low rates of oral glucose tolerance test uptake, screening with hemoglobin HbA1c or fasting glucose should be considered within the first year postpartum for those who do not complete an oral glucose tolerance test.[123]​

Those with impaired testing, but which is not diagnostic of diabetes mellitus, should be screened annually.[51]​​ Those with initially normal postpartum OGTT studies should be retested at least every 3 years.[1][51]

​​​Offspring of women with GDM should be monitored closely for development of diabetes and diabetes risk factors (obesity, sedentary lifestyle).[137][140]​​

Use of this content is subject to our disclaimer