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Screening, diagnosis, and management of gestational diabetes mellitus.

Abstract

Gestational diabetes mellitus (GDM) affects approximately 6% of pregnancies in the United States, and it is increasing in prevalence. Pregnant women without known diabetes mellitus should be screened for GDM after 24 weeks of gestation. Treatment of GDM results in a statistically significant decrease in the incidence of preeclampsia, shoulder dystocia, and macrosomia. Initial management includes glucose monitoring and lifestyle modifications. If glucose levels remain above target values, pharmacologic therapy with metformin, glyburide, or insulin should begin. Antenatal testing is customary for women requiring medications. Induction of labor should not occur before 39 weeks in women with GDM, unless glycemic control is poor or another indication for delivery is present. Unless otherwise indicated, scheduled cesarean delivery should be considered only in women with an estimated fetal weight greater than 4,500 g. Women with a history of GDM are at high risk of subsequently developing diabetes. These patients should be screened six to 12 weeks postpartum for persistently abnormal glucose metabolism, and should undergo screening for diabetes every three years thereafter.

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  • Authors+Show Affiliations

    Central City Community Health Center and the University of Utah, Salt Lake City, UT, USA.

    Source

    American family physician 91:7 2015 Apr 01 pg 460-7

    MeSH

    Blood Glucose
    Blood Glucose Self-Monitoring
    Delivery, Obstetric
    Diabetes, Gestational
    Female
    Humans
    Hypoglycemic Agents
    Insulin
    Life Style
    Postnatal Care
    Pregnancy
    Ultrasonography, Prenatal

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    25884746

    Citation

    Garrison, Andrew. "Screening, Diagnosis, and Management of Gestational Diabetes Mellitus." American Family Physician, vol. 91, no. 7, 2015, pp. 460-7.
    Garrison A. Screening, diagnosis, and management of gestational diabetes mellitus. Am Fam Physician. 2015;91(7):460-7.
    Garrison, A. (2015). Screening, diagnosis, and management of gestational diabetes mellitus. American Family Physician, 91(7), pp. 460-7.
    Garrison A. Screening, Diagnosis, and Management of Gestational Diabetes Mellitus. Am Fam Physician. 2015 Apr 1;91(7):460-7. PubMed PMID: 25884746.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Screening, diagnosis, and management of gestational diabetes mellitus. A1 - Garrison,Andrew, PY - 2015/4/18/entrez PY - 2015/4/18/pubmed PY - 2016/5/27/medline SP - 460 EP - 7 JF - American family physician JO - Am Fam Physician VL - 91 IS - 7 N2 - Gestational diabetes mellitus (GDM) affects approximately 6% of pregnancies in the United States, and it is increasing in prevalence. Pregnant women without known diabetes mellitus should be screened for GDM after 24 weeks of gestation. Treatment of GDM results in a statistically significant decrease in the incidence of preeclampsia, shoulder dystocia, and macrosomia. Initial management includes glucose monitoring and lifestyle modifications. If glucose levels remain above target values, pharmacologic therapy with metformin, glyburide, or insulin should begin. Antenatal testing is customary for women requiring medications. Induction of labor should not occur before 39 weeks in women with GDM, unless glycemic control is poor or another indication for delivery is present. Unless otherwise indicated, scheduled cesarean delivery should be considered only in women with an estimated fetal weight greater than 4,500 g. Women with a history of GDM are at high risk of subsequently developing diabetes. These patients should be screened six to 12 weeks postpartum for persistently abnormal glucose metabolism, and should undergo screening for diabetes every three years thereafter. SN - 1532-0650 UR - https://www.unboundmedicine.com/medline/citation/25884746/full_citation L2 - http://www.aafp.org/link_out?pmid=25884746 DB - PRIME DP - Unbound Medicine ER -