Feature Article

An update on gestational diabetes mellitus

Arianne N. Sweeting, Glynis P. Ross

Figures

© mihailomilovanovic/ istockphoto.com model used for illustrative purposes only
© mihailomilovanovic/ istockphoto.com model used for illustrative purposes only

Abstract

GPs play a key role in identifying and counselling women at high risk of gestational diabetes mellitus (GDM) before pregnancy, organising early testing to detect diabetes in pregnancy, ensuring timely postpartum follow-up and risk-factor modification and encouraging a healthy lifestyle to reduce the effects of GDM for women and their children. The Australasian Diabetes in Pregnancy Society revised consensus guidelines remain standard of care.

Key Points

  • Gestational diabetes mellitus (GDM) is associated with several short- and long-term adverse maternal and neonatal outcomes.
  • The prevalence of GDM in Australia has risen with an increase in maternal risk factors such as obesity and implementation of the revised Australasian Diabetes in Pregnancy Society (ADIPS) diagnostic criteria.
  • All women should be encouraged by their primary care provider to plan for pregnancy, and planning should include prepregnancy risk stratification and, in high-risk women, blood glucose assessment for detection of pre-existing glucose intolerance or undiagnosed diabetes.
  • High-risk women who have not undergone prepregnancy blood glucose assessment should be tested early for diabetes in pregnancy (DIP) and receive increased antenatal monitoring to reduce the risk of pregnancy complications.
  • Universal testing for GDM with a 75g two-hour oral glucose tolerance test (OGTT) at 24 to 28 weeks’ gestation is recommended.
  • Treatment of GDM ideally involves a multidisciplinary approach focusing on patient education, dietary modification and physical activity.
  • Women should monitor their blood glucose levels regularly, and pharmacotherapy (usually insulin) should be initiated if levels are elevated despite lifestyle optimisation.
  • GPs play a crucial role in prepregnancy counselling and in identifying and screening high-risk women for DIP before pregnancy or in early pregnancy.
  • GPs are ideally placed to facilitate postpartum follow-up and risk factor modification to reduce the increased risk of type 2 diabetes and cardiovascular disease in women with GDM and their offspring.

Figures

© mihailomilovanovic/ istockphoto.com model used for illustrative purposes only
© mihailomilovanovic/ istockphoto.com model used for illustrative purposes only