The American College of Obstetricians and Gynecologists (ACOG) has issued clinical management guidelines for the diagnosis and treatment of gestational diabetes mellitus (GDM) in pregnancy. The document provides a brief overview of the understanding of GDM, reviews management guidelines that have been validated by appropriately conducted clinical research, and identifies gaps in current knowledge. Among the recommendations offered:
Level A recommendations:
- Women in whom GDM is diagnosed should receive nutrition and exercise counseling, and when this fails to adequately control glucose levels, medication should be used for maternal and fetal benefit.
- When pharmacologic treatment of GDM is indicated, insulin is considered the first-line treatment for diabetes in pregnancy.
Level B recommendations:
- All pregnant women should be screened for GDM with a laboratory-based screening test(s) using blood glucose levels.
- In women who decline insulin therapy or for those women whom the obstetrician or obstetric care provider believes the patient will be unable to safely administer insulin, metformin is a reasonable second-line choice.
- Glyburide treatment should not be recommended as a first-line pharmacologic treatment because, in most studies, it does not yield equivalent outcomes to insulin.
- Health care providers should counsel women of the limitations in safety data when prescribing oral agents to women with GDM.
- Women with GDM should be counseled regarding the risks and benefits of a scheduled cesarean delivery when the estimated fetal weight is 4,500 g or more.
Gestational diabetes mellitus. Practice Bulletin No. 180. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e17–31.
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