Materiały źródłowe

• #1 Gestational diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/diagnosis-treatment/drc-20355345

  Treatment for gestational diabetes includes: […] Managing your blood sugar levels helps keep you and your baby healthy. Close management can also help you avoid complications during pregnancy and delivery. […] Lifestyle changes include: […] A healthy diet focuses on fruits, vegetables, whole grains and lean protein foods that are high in nutrition and fiber and low in fat and calories and limits highly refined carbohydrates, including sweets. […] Regular physical activity plays a key role in every wellness plan before, during and after pregnancy. Exercise lowers your blood sugar. […] While you’re pregnant, your health care team may ask you to check your blood sugar four or more times a day first thing in the morning and after meals to make sure your level stays within a healthy range.

• #2 How to Treat Gestational Diabetes | ADA

  https://diabetes.org/living-with-diabetes/pregnancy/gestational-diabetes/how-to-treat-gestational-diabetes

  Because gestational diabetes can affect you and your baby, it is key to start treatment quickly. […] Treatment for gestational diabetes (GDM) aims to manage blood glucose and reach target levels that are the same as those of pregnant women who don’t have GDM. Your treatment will include an eating plan and scheduled physical activity, and it may also include checking your blood glucose level and taking insulin. […] When you have GDM, you will need help from your health care team so that your treatment plan can change as needed. Your treatment plan will help lower the risk of a very large baby and the need for a cesarean section birth. […] Your treatment plan will give you a healthy pregnancy and birth, and help lower your babys risk for poor health in the future. […] And with this help, you can have a healthy pregnancy for you and a healthy start for your baby. […] It is hard to tell whether these women have GDM or have just started showing their diabetes during pregnancy, but they need to continue diabetes treatment after pregnancy. […] However, there are steps you can take to help prevent type 2 diabetes after GDM.

• #3 Treatment Options for Gestational Diabetes

  https://www.diabetesincontrol.com/treatment-options-for-gestational-diabetes/

  As gestational diabetes continues to rise globally, diabetes management teams are closely examining therapeutic trends and digital support solutions that empower both clinicians and patients. Surprisingly, despite its temporary nature, gestational diabetes demands careful management to avoid complications. Today, treatment strategies for this condition are expanding, combining clinical innovation with tech-enabled care models. […] The cornerstone of GDM treatment lies in maintaining optimal blood glucose levels throughout pregnancy. However, treatment must also prioritize maternal safety, fetal development, and ease of use for patients. […] For many women diagnosed with GDM, the first approach recommended is lifestyle modification. Medical nutrition therapy (MNT) and physical activity can control blood glucose in 70% to 85% of cases.

• #4 Gestational diabetes mellitus: A pragmatic approach to diagnosis and management

  https://www1.racgp.org.au/ajgp/2018/july/gestational-diabetes-mellitus

  Gestational diabetes mellitus (GDM) is a common condition with risks for mother and baby. […] Adverse maternal and fetal effects can be ameliorated by effective pregnancy management. […] The keys to management of GDM are optimisation of lifestyle, self-monitoring of blood glucose (SMBG), intensive patient education and introduction of medication when warranted. […] The combination of optimal diet and appropriate exercise will result in 50-70% of women with GDM achieving management targets. […] Effective monitoring is essential to GDM management. […] Target BGLs are an area of considerable debate, and at this time no evidence base supports specific targets. […] Metformin, including extended-release formulations, has not been shown to harm mother, fetus or child; however, long-term effects are still being assessed and currently it is not widely used in Australia. […] Insulin treatment in GDM is safe and effective and is usually the first choice of pharmacotherapy for GDM. […] Diagnosis and effective management of GDM improve maternal and fetal outcomes.

• #5 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?contenttypeid=85&contentid=P00337

  Treatment for gestational diabetes focuses on keeping your blood sugar levels in the normal range. Treatment may include: […] Special diet. You will meet with a registered dietitian (RD) to develop an individualized diet based on based on medical, lifestyle, and personal factors. Some general guidelines include eating vegetables, low-fat or nonfat dairy products, and protein such as lean meats, nuts, and seeds. Use healthy fats, like olive or canola oil. You should eat whole grains and avoid high-calorie snacks, sweet drinks, and sweet desserts. Limit fruit servings to a small piece of fruit or approximately 1 cup at a time. […] Exercise. You should do moderate exercise unless your healthcare provider tells you not to. […] Daily blood glucose monitoring. Your goals are to keep your fasting blood sugar level lower than 95 mg/dL, and your after eating (postprandial) blood sugar lower than 140 mg/dL 1 hour after eating or lower than 120 mg/dL 2 hours after eating. […] Insulin injections. You may need these to control your blood sugar levels. Or you may need other medicines taken by mouth.

• #6 Gestational Diabetes: Causes, Symptoms & Treatment | UW MedicineStethascopeHeart

  https://www.uwmedicine.org/conditions-symptoms/pregnancy-postpartum/gestational-diabetes

  Care for gestational diabetes mellitus (GDM) protects mother and child from high blood sugar during pregnancy. […] Treatment for gestational diabetes focuses on keeping your blood sugar levels in the normal range. Treatment may include: […] Special diet. You should eat 5 servings of vegetables, fruits, low-fat or nonfat dairy products, and lean meats. Use liquid fats for cooking instead of solid fats. You should eat whole grains and avoid high-calorie snacks or sweet desserts. […] Exercise. You should do moderate exercise unless your healthcare provider tells you not to. […] Daily blood glucose monitoring. Your goal is to keep your blood sugar levels lower than 130mg/dL to 140mg/dL 1 hour after eating. […] Insulin injections. You may need these to control your blood sugar levels. Or you may need other medicines taken by mouth.

• #7 Gestational Diabetes | ACOG

  https://www.acog.org/womens-health/faqs/gestational-diabetes

  Should I change my diet if I have GD? When women have GD, making healthy food choices is even more important to keep blood sugar levels from getting too high. If you have GD, you should eat regular meals throughout the day. You may need to eat small snacks as well, especially at night. Eating regularly helps avoid dips and spikes in your blood sugar level. Often, three meals and two to three snacks per day are recommended. […] Will regular exercise help me control GD? Exercise helps keep blood sugar levels in the normal range. You and your ob-gyn can decide how much and what type of exercise is best for you. In general, 30 minutes of moderate-intensity aerobic exercise at least 5 days a week is recommended (or a minimum of 150 minutes per week). Walking is a great exercise for all pregnant women. In addition to weekly aerobic exercise, it’s a good idea to add a walk for 10 to 15 minutes after each meal. This can lead to better blood sugar control.

• #8 Dietary Recommendations for Gestational Diabetes | UCSF Health

  https://www.ucsfhealth.org/education/dietary-recommendations-for-gestational-diabetes

  The first step in treating gestational diabetes is to modify your diet to help keep your blood sugar level in the normal range, while still eating a healthy diet. […] It is important to be meet with a registered dietitian to have your diet assessed. The dietitian will calculate the amount of carbohydrates that you need at meals and snacks. You will also be taught how to count carbohydrates. […] The following are dietary recommendations that will help you maintain safe blood sugar levels: […] Eating too much at one time can cause your blood sugar to rise too much. It is very important that you do not skip meals. […] Starchy foods eventually turn into glucose so it’s important not to be excessive. However, starch should be included in every meal. […] Milk is a healthy food and an important source of calcium. However, milk is a liquid form of carbohydrate and drinking too much at one time can raise your blood sugar.

• #9 Dietary Recommendations for Gestational Diabetes | UCSF Health

  https://www.ucsfhealth.org/education/dietary-recommendations-for-gestational-diabetes

  Fruit is a healthy food, but it is high in natural sugars. You may eat one to three portions of fruit per day, but only eat one at a time. […] Blood sugar can be difficult to control in the morning because of normal fluctuations in hormone levels. […] Juice is a concentrated source of carbohydrate. Because it is liquid, juice can raise blood sugar quickly. […] Cakes, cookies, candies and pastries tend to have excessive amounts of carbohydrate. […] Don’t add sugar, honey or syrup to your foods. […] The following sweeteners have been approved as safe to eat during pregnancy: Aspartame, Acesulfame K, Sucralose. […] Be sure to record all of the foods and the amount that you eat each day, which will help you monitor your carbohydrate intake.

• #10 Gestational Diabetes: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9012-gestational-diabetes

  Gestational diabetes is high blood sugar during pregnancy. Eating healthy, well-balanced foods and getting exercise can usually keep it well managed. But sometimes, insulin is necessary to help you manage blood sugar levels. […] Fortunately, gestational diabetes is well understood, and healthcare providers are usually able to help you manage the condition with small lifestyle and dietary changes. Most people dont experience serious complications from gestational diabetes and deliver healthy babies. […] If you have gestational diabetes, your pregnancy care provider will have you visit a nutritionist who specializes in gestational diabetes. At this appointment, youll talk about how certain foods typically increase blood sugar levels and how to make sure your meals and snacks contain the right types and amounts of food.

• #10 Gestational Diabetes: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9012-gestational-diabetes

  Some people need medication such as insulin to manage gestational diabetes. This usually involves injecting insulin into your stomach, thigh or buttocks every day or multiple times a day. […] The combination of tracking your blood sugar levels and eating diabetes-friendly food is usually enough to manage gestational diabetes. […] Your pregnancy care provider will test you for gestational diabetes after your baby is born to confirm its gone (usually around six to 12 weeks postpartum). […] Most babies born are born healthy. There are some steps you can take to manage gestational diabetes during pregnancy to give your child the best start in life. Attending all your prenatal appointments and managing diabetes the best you can during pregnancy are the two best things you can do. […] Most people can manage gestational diabetes with small changes to what they eat. A nutritionist or diabetes educator can help you with that. Still, some people need a medication called insulin to help keep their blood sugar in check.

• #11 Pregnancy and Gestational Diabetes: Causes, Risks, Management

  https://idf.org/about-diabetes/types-of-diabetes/gestational-diabetes/

  Gestational diabetes can be managed with a combination of lifestyle changes and medication. In most cases, women with gestational diabetes can manage their blood sugar levels by making dietary changes and exercising regularly. However, some women may need insulin or other medications to control their blood sugar levels during pregnancy. For most women with GDM, glucose levels return to normal after delivery and treatment is no longer necessary. […] Nutrition plays a crucial role in managing gestational diabetes. Generally, women with gestational diabetes should eat a diet rich in vegetables, whole grains, lean proteins and healthy fats. In addition, smaller, more frequent meals throughout the day can help regulate blood sugar levels. […] Regular physical activity is another factor that can contribute to better glycaemic control. Any movement or exercise can help regulate glucose levels in women with GDM. It can also prevent excessive weight gain and reduce the risk of complications during pregnancy.

• #12 Treatments for Gestational Diabetes

  https://www.everydayhealth.com/gestational-diabetes/guide/treatment/

  Exercise can help people manage weight gain and blood sugar. […] Experts advise getting at least 150 minutes of moderate-intensity aerobic exercise per week. […] Your doctor may ask you to monitor your glucose levels with a continuous glucose monitor or with a finger-stick monitor. […] For around 15 to 30 percent of people with gestational diabetes, diet and exercise are not enough. […] Your doctor may prescribe medication if you follow your diet and exercise plan and your glucose levels are still high after 10 to 14 days. […] If you need medication, insulin is suitable during pregnancy, as it cant cross the placenta. […] Your doctor will calculate the amount of insulin you need based on your weight and how many weeks you are pregnant. […] Options include metformin (Fortamet) and sulfonylureas, such as glyburide (Micronase).

• #13 Gestational Diabetes | OB-GYN

  https://health.ucdavis.edu/conditions/obgyn/pregnancy-complications-management/gestational-diabetes

  Your gestational diabetes diet should include fruits, vegetables, whole grains and lean proteins. We can connect you to a registered dietitian who can help you build a nutrition plan specifically to manage diabetes. […] Low-impact aerobic exercise, such as walking, swimming or yoga, is ideal for pregnant people. Talk to your healthcare provider about safe ways to stay active. […] Your healthcare provider may recommend insulin if diet and exercise aren’t enough to keep your blood glucose under control. Your provider will explain how and when you should take insulin.

• #14 Gestational diabetes – modern management and therapeutic approach (Review)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7725034/

  The optimal approach to glucose monitoring has not been determined. […] The ADA and American College of Obstetricians and Gynecologists (ACOG) recommended glucose targets are: i) FG level 95 mg/dl (5.3 mmol/l). […] Two pharmacologic options are available in pregnant women who need to better control their blood glucose: Different insulin regimens (several insulin analogues) and several selected antihyperglycemic oral agents (such as metformin or glyburide), along with medical and nutritional intervention. […] The first step in treating GDM is diet and in many cases the only one necessary, but if 30% of the targeted plasma glucose levels are exceeded (FPG95 mg/dl, 1-h PG over 140 mg/dl, 2-h PG over 120 mg/dl) it is a first criteria for introducing pharmacotherapy, insulin being the first choice and the only one approved by the FDA.

• #15 Gestational Diabetes (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/gestational-diabetes

  Gestational diabetes treatment and management. Treatment of GDM and good glycaemic control reduce serious perinatal morbidity and may also improve the woman’s health-related quality of life. It is often controversial as to when GDM requires treatment. A study showed that the treatment (dietary intervention, self-monitoring of blood glucose, and insulin therapy, if deemed necessary) of mild GDM (defined as positive OGTT but fasting glucose 5.3 mmol/L) did reduce the risks of fetal overgrowth, shoulder dystocia, caesarean delivery and hypertensive disorders but not a composite primary outcome (based upon stillbirth or perinatal death and neonatal complications, including hyperbilirubinaemia, hypoglycaemia, hyperinsulinaemia and birth trauma). […] Women should receive routine antenatal care but in addition: Monitoring blood glucose. Advise pregnant women with GDM who are on a multiple daily insulin injection regimen to test their fasting pre-meal, one hour post-meal and bedtime blood glucose levels daily during pregnancy. Advise pregnant women with GDM to test their fasting and one hour post-meal blood glucose levels daily during pregnancy if they are on diet and exercise therapy, or taking oral therapy (with or without diet and exercise therapy) or single-dose intermediate-acting or long-acting insulin. Target blood glucose levels. Agree individualised targets for self-monitoring of blood glucose, taking into account the risk of hypoglycaemia. Advise maintaining capillary plasma glucose below the following target levels, if these are achievable without causing problematic hypoglycaemia: fasting glucose 5.3 mmol/L and glucose levels 7.8 mmol/L one hour after meals, or 6.4 mmol/L two hours after meals. Advise women with GDM, who are on insulin or glibenclamide, to maintain their capillary plasma glucose level above 4 mmol/L.

• #16 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  You will learn how to check your blood sugar level and record the results. […] Approximately 15 percent of patients with gestational diabetes will require insulin. Insulin is a medicine that helps to reduce blood sugar levels and can reduce the risk of gestational diabetes-related complications. […] If you take insulin, you should check your blood sugar level at least four times per day. […] Oral diabetes medicines, such as those taken by people with type 2 diabetes, are sometimes used during pregnancy in the United States. […] Most pregnant individuals who develop gestational diabetes have more frequent prenatal visits, especially if insulin is used. […] After giving birth, most individuals with gestational diabetes have normal blood sugar levels and do not require further treatment with insulin.

• #17 Managing & Treating Gestational Diabetes – NIDDK

  https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational/management-treatment

  Many women with gestational diabetes can manage their blood glucose levels by following a healthy eating plan and being physically active. Some women also may need diabetes medicine. […] If following your eating plan and being physically active aren’t enough to keep your blood glucose levels in your target range, you may need insulin. […] If you need to use insulin, your health care team will show you how to give yourself insulin shots. Insulin will not harm your baby and is usually the first choice of diabetes medicine for gestational diabetes. Researchers are studying the safety of the diabetes pills metformin and glyburide during pregnancy, but more long-term studies are needed. Talk with your health care professional about what treatment is right for you.

• #18 Treatment of Gestational Diabetes | IntechOpen

  https://www.intechopen.com/chapters/67733

  Improving the pregnancy outcome in women with GDM can be achieved through maintenance of fasting blood sugar levels 95 mg/dl (5.3 mmol/L), 1-h postprandial blood sugar 140 mg/dl (7.8 mmol/L), and 2-h postprandial blood sugar 120 mg/dl as recommended by both the American College of Obstetricians and Gynecologists (ACOG) and American Diabetes Association. […] The treatment of GDM starts with dietary modifications along with particular nutritional approaches combined with exercise. […] If this combination failed to maintain the needed glucose levels, pharmacological treatment starts, regardless of the lines used for treatment, proper monitoring of maternal health, fetal condition, and blood sugar levels. […] Pharmacologic treatment is indicated when dietary management and exercise failed to achieve the target glucose levels.

• #19 How to manage and reduce the risk of gestational diabetes | Your Pregnancy Matters | UT Southwestern Medical Center

  https://utswmed.org/medblog/gestational-diabetes-treatment/

  Eating a healthy, diabetes-friendly diet can be the key to reducing the risk of gestational diabetes. […] Maintaining a healthy weight and lifestyle, including regular exercise, will help control your blood sugar before pregnancy, and is the best way to reduce the risk of gestational diabetes. Because we do not generally recommend weight loss during pregnancy, treatment typically focuses on eating nutritious foods and use of medications to lower blood sugar as needed. […] Eating a diabetes-friendly diet is the key to managing gestational diabetes. These diets typically emphasize protein and avoid carbohydrates and sugar. […] If eating differently isnt helping, we might prescribe insulin to treat high blood sugar. Insulin is safe and effective, and it doesnt affect the babys development. […] When women can manage gestational diabetes with a healthy diet and medication (when its needed), they typically deliver their babies with no setbacks.

• #20 Gestational diabetes – medication treatment options | CUH

  https://www.cuh.nhs.uk/patient-information/gestational-diabetes-medication-treatment-options/

  For many women diet and physical activity are enough to keep blood glucose levels in the healthy range for pregnancy, however for some, additional treatment options need to be considered. This leaflet provides you with information about treatment options. […] Understandably women are cautious about taking medication during pregnancy, but it is better for your babys wellbeing to be exposed to blood glucose levels in the healthy range for pregnancy, even if this can only be achieved with the support of medication. […] There are very few medications to lower blood glucose levels suitable for use in pregnancy; they include Metformin and Insulin, alone or in combination. […] The insulin that you take does not cross the placenta to your baby. […] Metformin is a tablet that has been given approval for use in pregnancy by NICE (National Institute for Clinical Excellence) and more recently by the Medicines and Healthcare Products Regulatory Agency and the Commission on Human Medicines. It is known that Metformin crosses the placenta but research has shown no safety concerns around the use of Metformin in pregnancy. Metformin can be use alone or to supplement the use of injected insulin during pregnancy if clinically indicated.

• #21

  https://www.nhs.uk/conditions/gestational-diabetes/treatment/

  If you have gestational diabetes, the chances of having problems with the pregnancy can be reduced by controlling your blood sugar (glucose) levels. […] You’ll also need to be more closely monitored during pregnancy and labour to check if treatment is working and for any problems. […] You may be given medicine if your blood sugar levels are still not stable 1 to 2 weeks after changing your diet and exercising regularly, or if your blood sugar level is very high when you’re first diagnosed. This may be tablets usually metformin or insulin injections. […] Your blood sugar levels can increase as your pregnancy progresses, so even if they improve at first, you may need to take medicine later in pregnancy. […] Insulin may be recommended if: you cannot take metformin or it causes side effects, metformin does not lower your blood sugar levels enough, you have very high blood sugar, your baby is very large or you have too much fluid in your womb (polyhydramnios). […] During labour and delivery, your blood sugar will be monitored and kept under control. You may need to have insulin given to you through a drip, to control your blood sugar levels. […] Any medicines you were taking to control your blood sugar will usually be stopped after you give birth.

• #22 Treatment of Gestational Diabetes | IntechOpen

  https://www.intechopen.com/chapters/67733

  Basically, insulin is the standard treatment for GDM. […] Insulin has the advantage of non-crossing of the placenta. […] The insulin analogs as insulin aspart and lispro are preferred over the regular insulin as a short-acting type. […] Historically oral hypoglycemics should be avoided as early agents cross the placenta, resulting in fetal hyperinsulinemia with subsequent macrosomia and congenital malformations. […] Now their use in GDM is increasing despite them not approved by the US Food and Drug Administration and the recommendation of ADA that insulin is the first-line therapy for GDM. […] Metformin is a biguanide that decreases intestinal glucose absorption and hepatic gluconeogenesis and increases peripheral glucose uptake. […] Although metformin can cross the placenta, its long-term metabolic effects on the growing fetus are not known.

• #23 Current Management of Gestational Diabetes Mellitus

  https://www.medscape.com/viewarticle/568728

  Exogenous insulin is used when diet and exercise fail to maintain euglycemia. Some recently developed insulin analogues, like aspart and lispro, may be considered a valuable treatment option in patients with GDM. […] Oral hypoglycemic agents are not currently recommended as a treatment for GDM. […] For insulin-treated GDM patients there is no universal recommendation to labor induction at approximately 38-39 weeks. […] Patients with insulin-requiring diabetes need intrapartum capillary hourly monitoring of blood glucose levels and maintaining glycemic values between 80 and 110 mg/dl during labor. […] Postpartum periodic glucose tolerance tests need to previously identify glucose abnormalities and, consequently, to begin strategies for the prevention of diabetes.

• #24 Gestational Diabetes Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/gestational-diabetes/

  Gestational diabetes is high blood sugar that is first diagnosed during pregnancy. High blood sugar can cause problems for you and your baby. With treatment and lifestyle changes, you can manage your blood sugar and have a healthy baby. Blood sugar levels often go back to normal after you give birth. […] Managing your blood sugar is the key to preventing problems during pregnancy, birth, and after your baby is born. You may be able to manage your blood sugar with a healthy diet and regular exercise. You may also need to take diabetes medicine or give yourself insulin shots. […] You may need to check your blood sugar at home to see if it’s staying in your target range. If it isn’t, you may need to take diabetes medicine or give yourself insulin shots. […] Diabetes medicine, such as insulin or pills, can help keep your blood sugar level in your target range. If you need to take insulin, you’ll learn how to give yourself an insulin shot. […] You may need more insulin as you get closer to your delivery date. That’s because over time the placenta makes more and more hormones. This makes it harder and harder for insulin to do its job.

• #25 Managing Gestational Diabetes

  https://www.uspharmacist.com/article/managing-gestational-diabetes

  Gestational diabetes mellitus (GDM) affects a significant percentage of U.S. pregnancies, rising from 6.0% in 2016 to 8.3% in 2021, with higher rates in older mothers. […] Management includes blood glucose monitoring, lifestyle changes, and medication when necessary. […] Treatment for GDM involves pharmacologic therapy as one of the options when lifestyle modifications alone are insufficient to control BGCs. […] The three drugs commonly considered for GDM treatment are insulin, metformin, and glyburide. […] For GDM management, insulin remains the optimal selection, particularly in the context of addressing type 1 diabetes (T1D) during pregnancy. […] Insulin can be administered through either multiple daily injections or insulin pump technology in pregnant women with T1D. […] Metformin presents an alternative approach for the treatment of GDM, demonstrating potential benefits such as a decreased risk of neonatal hypoglycemia and reduced maternal weight gain, when compared with the use of insulin.

• #26 Pharmacotherapy of Gestational Diabetes Mellitus: Current Recommendations | IntechOpen

  https://www.intechopen.com/chapters/78883

  The incidence of gestational diabetes mellitus (GDM) is still rising, and this pathological condition is strongly associated with some serious adverse pregnancy outcomes. Therefore, GDM must be timely recognized and adequately managed. Treatment of GDM is aimed to maintain normal glycemia and it should involve regular glucose monitoring, dietary modification, lifestyle changes, moderate physical activity, and pharmacotherapy, when necessary. […] As for the pharmacotherapy, needed in approximately one-third of GDM women, insulin administration is the first choice of pharmacological treatment, although oral hypoglycemic drugs, for example, metformin (a biguanide agent) or glyburide (a second-generation sulfonylurea drug), could be indicated, too. Metformin is considered as a reasonable and safe first-line alternative to insulin.

• #27 Managing Gestational Diabetes

  https://www.uspharmacist.com/article/managing-gestational-diabetes

  Glyburide, a sulfonylurea, is generally the least-preferred drug for GDM treatment. […] In the postpartum period, managing GDM involves monitoring BGCs and making timely adjustments to insulin dosages during the early postpartum days. […] Continued postpartum care is critical, with regular screening for T2D or prediabetes recommended throughout life, every 1 to 3 years for those with previous GDM. […] Regular screenings for T2D should be promoted for long-term health management.

• #28 Gestational Diabetes Mellitus: Screening and Management – The ObG Project

  https://www.obgproject.com/2023/01/02/acog-releases-updated-guidance-gestational-diabetes/

  Gestational diabetes mellitus (GDM) has become increasingly prevalent worldwide. Class A1GDM refers to diet-controlled GDM. Class A2GDM refers to the clinical scenario where medications are required. The following synopsis highlights key practice points from various professional organizations. […] ACOG recommends that insulin be the preferred therapy if glycemic control is not obtained with nonpharmacologic treatment. Substantial number of patients started on oral therapy will require insulin during pregnancy. […] If a patient cannot take insulin or declines, metformin can be used. Counsel about metformin risks including placental cross over and no long term studies in offspring available. […] Glyburide should not be used in place of insulin as studies show worse outcome, including macrosomia and birth injury.

• #29 Diagnosis and Management of Gestational Diabetes

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-gestational-diabetes

  GDM more than doubles the risk of perinatal morbidity and mortality, and this risk progressively increases with the severity of hyperglycemia and decreases with treatment, including both lifestyle changes and pharmacotherapy. […] The mainstays of GDM treatment begin with lifestyle interventions, including nutritional counseling, dietary changes, and daily exercise, with the goal of decreasing postprandial hyperglycemia. […] Once the patient commences an appropriate diet and exercise plan, close surveillance of blood glucose levels is necessary to ensure glycemic control is maintained. […] The challenge is that at least 1 in 4 women with GDM do not respond to lifestyle intervention, including diet and exercise, and require pharmacotherapy to achieve euglycemia. […] Both the ACOG and ADA recommend insulin as first-line therapy because it does not cross the placenta and improves perinatal outcomes.

• #30 Diabetes Mellitus in Pregnancy – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/pregnancy-complicated-by-disease/diabetes-mellitus-in-pregnancy

  Gestational diabetes occurs in approximately 4% of pregnancies, but the rate is above average in people of certain ethnicities (non-Hispanic Asian/Pacific Islander and Hispanic/Latina). Women with gestational diabetes are at increased risk of type 2 diabetes in the future. […] Guidelines for managing diabetes mellitus during pregnancy are available from the American College of Obstetricians and Gynecologists (ACOG). […] Preconception counseling and optimal control of diabetes before, during, and after pregnancy minimize maternal and fetal risks, including congenital malformations. […] To minimize risks, clinicians should do all of the following: Involve a diabetes team (eg, physicians, nurses, nutritionists, social workers) and a pediatrician. […] Insulin is the traditional treatment of choice because it cannot cross the placenta and provides more predictable glucose control; it is used for types 1 and 2 diabetes and for some women with gestational diabetes.

• #31 Managing gestational diabetes | Diabetes Australiachevron

  https://www.diabetesaustralia.com.au/managing-diabetes/gestational/

  If your blood glucose levels aren’t in your target range following changes to diet and exercise, you might need to take tablets, or have insulin injections. This is to make sure your levels are where they need to be so that your risk of any complications can be minimised. […] Taking tablets and insulin as directed is safe for both you and your baby. […] There are many health professionals who can help you. This includes specialist doctors, diabetes educators and dietitians. […] Gestational diabetes usually goes away by itself after your baby is born and you should be able to stop taking any gestational diabetes medication after childbirth. […] To make sure your blood glucose levels remain stable, you will be advised to have an oral glucose tolerance test (OGTT) six to twelve weeks after your baby is born. […] Your GP will do regular tests every couple of years to check for Type 2 diabetes, because of your increased risk and the symptoms are often silent and go unnoticed.

• #31 Managing gestational diabetes | Diabetes Australiachevron

  https://www.diabetesaustralia.com.au/managing-diabetes/gestational/

  If you’ve just been diagnosed with gestational diabetes, don’t panic. […] In most instances gestational diabetes can be managed effectively so that women can have a pregnancy and birth free of serious complications. […] The good news is that the risk of complications is greatly reduced when gestational diabetes is diagnosed and managed. Managing gestational diabetes means that you can have a healthy pregnancy and options for your birth. […] Healthy eating helps keep your blood glucose levels in the recommended range and can stop you from gaining too much weight. […] Unless you have been told not to exercise by your healthcare team, some moderate intensity exercise is good for you, your baby and managing gestational diabetes. […] Monitoring your blood glucose levels is an essential part of managing gestational diabetes.

• #32 Gestational diabetes – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/diagnosis-treatment/drc-20355345

  If diet and exercise aren’t enough to manage your blood sugar levels, you may need insulin injections to lower your blood sugar. […] An important part of your treatment plan is close observation of your baby. […] Your health care provider will check your blood sugar level after delivery and again in 6 to 12 weeks to make sure that your level has returned to within the standard range. […] If future tests indicate type 2 diabetes or prediabetes, talk with your health care provider about increasing your prevention efforts or starting a diabetes management plan.

• #33 Diagnosis and Management of Gestational Diabetes

  https://www.contemporaryobgyn.net/view/diagnosis-and-management-of-gestational-diabetes

  Insulin is generally the preferred first-line pharmacotherapy, but further research is needed with regard to the efficacy and safety of oral agents, particularly metformin. […] Women with well-controlled GDM are at low risk of intrauterine fetal demise, and hence routine antepartum fetal testing is generally not initiated for uncomplicated diet-controlled class A1 GDM. […] All women with GDM should be screened for glucose intolerance and type 2 diabetes in the postpartum period with follow-up based on their 75-g oral GTT results.

• #34 Treatment of Gestational Diabetes

  https://www.webmd.com/diabetes/understanding-gestational-diabetes-treatment

  If you have gestational diabetes, you’ll need to get your blood sugar under control, and keep it that way, to protect your health and your baby’s. Youll have to make some lifestyle changes for that to happen. […] Your doctor might suggest you meet with a registered dietitian to help you make a diet plan you can stick with. It will need to address the gestational diabetes, but still provide your growing baby enough calories and nutrients. […] Your doctor may tell you to add exercise to your weekly routine if its OK for you and the baby. […] Make sure the diet changes and added exercise get your blood sugar levels under control. […] If your blood sugar remains high despite these changes, the doctor may prescribe diabetes pills to keep it in check and protect your baby. […] Depending on how well-controlled your diabetes is and how your pregnancy is progressing, the doctor may track your babys size more closely during the last weeks or months before your due date. […] After delivery, the doctor will check to make sure your blood sugar levels have returned to normal. You’ll need to have your levels rechecked about 6 weeks after delivery, and then yearly after that.

• #35 Gestational diabetes – medication treatment options | CUH

  https://www.cuh.nhs.uk/patient-information/gestational-diabetes-medication-treatment-options/

  It is important to keep your blood glucose levels within the healthy range for pregnancy, right up to the point of birth. This means that during labour, you will continue to take your usual doses of Metformin and remain on the gestational diabetes diet until your baby is born. If your blood glucose levels rise above 8.0mmol/l during labour, your care team may advise that you change to an infusion of insulin through a drip, for the remainder of your labour. […] Once your baby is born you should stop taking the Metformin (unless you have been advised otherwise by the pregnancy team) and return to a normal healthy diet but we ask you to continue to check your blood glucose levels for 24 hours.

• #36 Patient education: Gestational diabetes (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics/print

  However, your doctor may check your blood sugar level the day after delivery to be sure that it is normal or near normal. […] The American Diabetes Association (ADA) recommends that all persons with a history of gestational diabetes have testing for type 2 diabetes every one to three years after their initial post-pregnancy test for diabetes.

• #37 Gestational diabetes – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339

  Gestational diabetes is diabetes diagnosed for the first time during pregnancy (gestation). […] During pregnancy you can help control gestational diabetes by eating healthy foods, exercising and, if necessary, taking medication. […] If you develop gestational diabetes, you may need checkups more often. […] There are no guarantees when it comes to preventing gestational diabetes but the more healthy habits you can adopt before pregnancy, the better. […] If you’ve had gestational diabetes, these healthy choices may also reduce your risk of having it again in future pregnancies or developing type 2 diabetes in the future. […] Eating healthy foods, keeping active, starting pregnancy at a healthy weight, and not gaining more weight than recommended can help manage gestational diabetes.

• #38 Gestational Diabetes | Women and Infants in Rhode Island |

  https://www.womenandinfants.org/services/pregnancy/high-risk/gestational-diabetes

  Gestational diabetes is treated with a special and individualized meal plan and, in some cases, exercise. Blood sugar levels need to be checked, either at a laboratory or at home with a glucometer. Some women may need medication (insulin is preferred) injections during the pregnancy. […] Our physicians can help you manage your blood glucose levels while you continue to see your obstetrician for prenatal care. Your obstetrician can arrange this service by calling (401) 274-1122, ext. 47457. […] Women with gestational diabetes have an increased risk of developing diabetes in the future. They should be tested for diabetes regularly after the baby is born. This risk can be reduced by keeping a healthy weight, eating a healthy diet, and exercising regularly. Breastfeeding reduces both the moms risk and her babys risk of developing diabetes someday.

• #39 Gestational diabetes mellitus: Glucose management, maternal prognosis, and follow-up – UpToDate

  https://www.uptodate.com/contents/gestational-diabetes-mellitus-glucose-management-maternal-prognosis-and-follow-up

  Treatment of gestational diabetes mellitus (GDM) can improve pregnancy outcome. Many patients can achieve target glucose levels with nutritional therapy and moderate exercise alone, but up to 30 percent will require pharmacotherapy. […] Even patients with mildly elevated glucose levels who do not meet standard criteria for GDM may have more favorable pregnancy outcomes if treated since the relationship between glucose levels and adverse pregnancy outcomes such as macrosomia exists continuously across the spectrum of increasing glucose levels. […] Patients with GDM are treated to minimize maternal and neonatal morbidity. In a United States Preventive Services Task Force (USPSTF) meta-analysis of randomized trials, compared with no treatment, treatment (which generally included nutritional therapy, blood glucose monitoring, and insulin administration when target blood glucose concentrations were not met) resulted in reductions in newborn birth injury and shoulder dystocia.

• #40 Gestational diabetes

  https://elsevier.health/en-US/preview/gestational-diabetes-co

  Gestational diabetes is any degree of glucose intolerance with onset or first recognition during pregnancy. Mainstay of treatment consists of lifestyle changes and, when necessary, insulin or oral hypoglycemic agents to achieve specified glycemic targets. Treatment of gestational diabetes can reduce the rate of adverse pregnancy outcomes, including macrosomia, fetal adiposity, preeclampsia, and gestational hypertension. Treatment of gestational diabetes is associated with improved health outcomes. Treat patients with severe hyperglycemia (ie, glucose levels indicative of overt diabetes) with insulin immediately. Lifestyle modifications (eg, medical nutrition therapy, exercise, weight management) are used as first line therapy. Most patients with gestational diabetes should monitor fasting and postprandial capillary blood glucose levels as a strategy to achieve optimal metabolic control. First line pharmacotherapy (when required) is insulin. Insulin is the preferred medication for treating hyperglycemia in gestational diabetes according to the American Diabetes Association. Oral hypoglycemic agents are used as alternatives only when insulin administration may be unsafe or unfeasible. Aspirin can be used to lower the risk of preeclampsia. Patients with good glycemic control and no complications may deliver at term. Recommend breastfeeding immediately after delivery (to prevent neonatal hypoglycemia) and encourage mother to continue it for at least 4 months. Treatment of gestational diabetes is associated with improved health outcomes.

• #41 Precision gestational diabetes treatment: a systematic review and meta-analyses | Communications Medicine

  https://www.nature.com/articles/s43856-023-00371-0

  A precision medicine approach resulting in more rapid normalization of hyperglycaemia could have substantial benefits for both mother and fetus. […] However, we found a number of precision markers to enable earlier identification of those requiring escalation of pharmacological therapy. These included characteristics such as BMI, that are easily and routinely measured in clinical practice, and thus have potential to be integrated into prediction models with the aim of achieving rapid glycaemic control. […] Basing treatment decisions closely on precision markers could also avoid over-medicalisation of women who are likely to achieve glucose targets with dietary counselling alone. […] Our findings suggest that precision medicine for GDM treatment holds promise as a tool to streamline individuals towards the most effective and potentially cost-effective care.

• #42 Gestational Diabetes | Diabetes | CDC

  https://www.cdc.gov/diabetes/about/gestational-diabetes.html

  Gestational diabetes can develop during pregnancy in women who don’t already have diabetes. Managing gestational diabetes can help make sure you have a healthy pregnancy and a healthy baby. […] It’s important to be tested for gestational diabetes so you can begin treatment to protect your baby’s health and your own. […] You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including: Checking your blood sugar to make sure your levels stay in a healthy range. Being active lowers your blood sugar and makes you more sensitive to insulin. Eating healthy food in the right amounts at the right times. […] If healthy eating and being active aren’t enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.

• #43 How to manage gestational diabetes | March of Dimes

  https://www.marchofdimes.org/find-support/blog/how-to-manage-gestational-diabetes

  Gestational diabetes (also called gestational diabetes mellitus) is a kind of diabetes that can happen during pregnancy. But if your diabetes is treated and controlled, you can have a healthy pregnancy and a healthy baby. Heres what you can do to manage gestational diabetes: […] Monitor your blood sugar: Check your blood sugar regularly and keep a log to track it. This can help your provider monitor your treatment. Your provider can show you how to measure your blood sugar and tell you how often to check it. […] Take medicine, if your provider prescribes it: Your provider may want you to take medicine called insulin to control your blood sugar. If your provider prescribes insulin, take it exactly as she tells you to.

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