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Gestational Diabetes

Epidemiology: Prevalence
1. Overall: 2-5% of pregnant women in U.S.
2. High risk groups (see below): 14%
Risk Factors Predictive of Gestational Diabetes
1. Maternal Age > 30 years
2. Family History of Diabetes Mellitus
3. Personal History of Diabetes Mellitus
  1. Previous abnormal lab testing
    1. Glucose Challenge Test (GCT)
    2. Glucose Tolerance Test (GTT)
    3. Glycosuria (Urine Glucose positive)
  2. Symptoms of Diabetes Mellitus
    1. Polyuria (pre-pregnant)
    2. Polydypsia
    3. Blurred vision
4. Prior Pregnancy Complication
  1. History of infant with Macrosomia
    1. Weight exceeds 4000 grams or 9 pounds
  2. History of infant with congenital anomaly
  3. Prior stillbirth
  4. Habitual Abortions
  5. Preeclampsia
  6. Polyhydramnios
5. Obesity
6. Hypertension
7. Recurrent Urinary Tract Infection
8. Recurrent Vaginitis
Labs
1. Glucose Challenge Test (GCT)
  1. Abnormal if Serum Glucose exceeds 130 mg/dl
  2. Timing of Test
    1. High Risk (See Risk Factors above)
      1. Perform GCT at initial visit
      2. Rescreen GCT at 24-28 weeks if initially negative
    2. Low Risk
      1. First Screen at 24-28 weeks
2. Glucose Tolerance Test
  1. Indicated for abnormal Glucose Challenge Test
Fetal Complications Associated with Gestational Diabetes
1. Fetal Macrosomia
  1. Operative delivery risk (Ceserean section)
  2. Birth Trauma risk
  3. Shoulder Dystocia
2. Hypoglycemia
3. Hypothermia
4. Hyperbilirubinemia,
5. Hypocalcemia
6. Premature birth
7. Respiratory distress syndrome
8. Polycythemia Vera (plethora)
9. Obesity during childhood
Maternal Complications of Gestational Diabetes
1. Longterm risk of developing Diabetes Mellitus: 50%
  1. Consider diabetes screening annually
2. Hypertension
3. Preeclampsia
4. Ceserean Section
Prognosis
1. See Gestational Diabates perinatal mortality
References
1. (2001) Obstet Gynecol 98:525

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 7/1/2009. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.