Title:The Management of Gestational Diabetes
VOLUME: 8 ISSUE: 4
Author(s):Caroline Ovadia and Archana Dixit
Affiliation:West Middlesex University Hospital, Twickenham Road, Isleworth, London, Middlesex, TW7 6AF, UK.
Keywords:Gestational diabetes, management, metformin, glibenclamide, insulin, vitamin D, labour, ACHOIS trials, hypoglycaemic, corticosteroids
Abstract:The incidence of gestational diabetes is increasing, with higher obesity in the pregnant population, lifestyle
changes and migration thought to underlie this. Recent large studies, such as the MiG, HAPO and ACHOIS trials, have
furthered our understanding of both the implications of the disease and the management options available. Previous CEMACH
(Confidential Enquiries into Maternal and Child Health) studies of diabetes in pregnancy have shown a significant
proportion of patients receiving sub-optimal care. We aim to summarise the current standard of management strategies in
pregnancy, whilst acknowledging controversies and limitations in the existing evidence. Antenatal management involves
service organisation to provide multi-disciplinary team reviews to address glycaemic control, fetal monitoring and associated
conditions such as obesity and hypertensive disorders of pregnancy. The use of diet, exercise, oral hypoglycaemic
agents and insulins will be discussed, along with specific considerations for the management of preterm labour and administration
of corticosteroids for fetal lung maturity. The timing and management of labour, including mechanisms of
delivery, will be covered, including neonatal considerations and the use of breast feeding. Finally, a discussion of appropriate
post delivery care will consider the prevention of, and screening for, the development of type 2 diabetes.
