Gestational Diabetes

Aka: Gestational Diabetes, Gestational Diabetes Mellitus

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II. Epidemiology: Prevalence

  1. Overall: 6 to 9% of pregnant women in U.S. (2017)
    1. Incidence doubled between 2006 and 2017
  2. High risk groups (see below): 14%

III. Pathophysiology

  1. Pancreatic Beta cell hyperplasia is normal in pregnancy
    1. Higher Fasting and postprandial Insulin levels
  2. Placental Hormones increase Insulin Resistance (esp. third trimester)
  3. Gestational Diabetes results when increased beta cell function does not overcome Insulin Resistance

IV. Risk Factors

  1. Maternal Age > 35 years old (OR 1.6)
  2. Family History of Diabetes Mellitus in first degree relative (RR 1.7)
  3. Body Mass Index >25 kg/m2 (OR 3.2) and esp. BMI >40 kg/m2
  4. Weight gain >11 lb (5 kg) since 18 years old (RR 1.7)
  5. Personal History of Diabetes Mellitus
    1. See Diabetes Mellitus Preconception Counseling
    2. Previous abnormal lab testing
      1. Gestational Diabetes diagnosis in prior pregnancy (OR 13.2)
      2. Glucose Challenge Test (GCT)
      3. Glucose Tolerance Test (GTT)
      4. Glycosuria (Urine Glucose positive)
    3. Symptoms of Diabetes Mellitus
      1. Polyuria (pre-pregnant)
      2. Polydypsia
      3. Blurred Vision
  6. Prior Pregnancy Complication
    1. History of infant with Macrosomia (OR 1.4)
      1. Weight exceeds 4000 grams or 9 pounds
    2. Excessive gestational weight gain (OR 1.4)
    3. History of infant with Congenital Anomaly
    4. Prior Stillbirth
    5. Habitual Abortions
    6. Preeclampsia
    7. Polyhydramnios
  7. Ethnicity
    1. Asian (RR 2.3)
    2. Native American (RR 2.1)
    3. Pacific Islander (RR 2.1)
    4. Black (RR 1.8)
    5. Hispanic (RR 1.5)
  8. Other associated factors
    1. Hypertension
    2. HIV Infection
    3. Polycystic Ovary Syndrome of Insulin Resistance signs (e.g. Acanthosis Nigricans)
    4. Recurrent Urinary Tract Infection
    5. Recurrent Vaginitis
  9. References
    1. Getahun (2010) Am J Obstet Gynecol 203(5): 467 [PubMed]

V. Labs: Screening - Two Step

  1. Alternative to Two step screening is a single Glucose Tolerance Test 2 hour (OGTT)
  2. Glucose Challenge Test (GCT)
    1. Non-Fasting patient drinks 50 grams of Glucose and has Serum Glucose drawn at 1 hour
    2. Abnormal if Serum Glucose exceeds 130 mg/dl (some organizations use 140 mg/dl cutoff)
    3. Empiric Gestational Diabetes Management for GCT >200 mg/dl (without a 3 hour GTT)
    4. Timing of Test
      1. High Risk (See Risk Factors above)
        1. Test at initial Antepartum Visit to identify preexisting, undiagnosed Diabetes Mellitus (choose one)
          1. Hemoglobin A1C >=6.5% Preexisting Diabetes (>5.9% Glucose Intolerance) OR
          2. Fasting plasma Glucose >=126 mg/dl preexisting diabetes (>110 mg/dl Glucose Intolerance) OR
          3. Abnormal Glucose Tolerance Test 2 hour (OGTT)
        2. Rescreen GCT at 24-28 weeks for Gestational Diabetes if initially negative
      2. Low Risk
        1. Perform GCT at 24-28 weeks
      3. Other Indications
        1. May be considered later in pregnancy for polyhydramnios
  3. Glucose Tolerance Test 3 hour
    1. Indicated for abnormal Glucose Challenge Test
    2. Fasting patient drinks 100 grams of Glucose
    3. Serum Glucose drawn Fasting, 1,2, 3 hours
    4. Interpretation
      1. See Glucose Tolerance Test
      2. Abnormal if 2 or more readings over respective cut-offs
      3. Thresholds for Fasting and 1, 2, and 3 hours
        1. Carpenter-Coustan (preferred): Glucose 95, 180, 155 and 140 mg/dl)
        2. NDDG (older guidelines): Glucose 105, 190, 165 and 145 mg/dl)

VI. Management

  1. See Gestational Diabetes Management
  2. See Gestational Diabetes Insulin Management
  3. See Gestational Diabetes Insulin Management Intrapartum

VII. Complications: Fetal

  1. Fetal Macrosomia with weight > 4000 grams (RR 1.6)
    1. Large for Gestational Age (LGA) >90th percentile
    2. Operative delivery risk (Ceserean section)
    3. Shoulder Dystocia or other Birth Trauma risk (RR 2.9)
  2. Hypoglycemia
  3. Hypothermia
  4. Hyperbilirubinemia
  5. Hypocalcemia
  6. Premature birth
  7. Respiratory distress syndrome
  8. Polycythemia Vera (plethora)
  9. Obesity during childhood (RR 1.5)
  10. Birth defects (RR 1.2)

VIII. Complications: Maternal

  1. Longterm risk of developing Diabetes Mellitus
    1. Consider periodic Diabetes Screening, Prediabetes and lifestyle management
    2. Bellamy (2009) Lancet 373(9677):1773-9 +PMID:19465232 [PubMed]
  2. Gestational Diabetes Mellitus in future pregnancy (RR 7.4)
  3. Gestational Hypertension (RR 1.6)
  4. Preeclampsia (RR 1.5)
  5. Ceserean Section (RR 1.3)

IX. Prognosis

  1. See Gestational Diabates perinatal mortality
  2. Adverse perinatal outcomes (see above) include infant death, Shoulder Dystocia, Fracture, nerve palsy
  3. Maternal and fetal outcomes are significantly improved with good Blood Sugar control
    1. Adverse perinatal outcomes are reduced from 4% without treatment to <1% with treatment
    2. Crowther (2005) N Engl J Med 352(24): 2477-86 [PubMed]
    3. Metzger (2008) N Engl J Med 358(19): 1991-2002 [PubMed]

X. Prevention

  1. Preconception weight loss, dropping BMI 1 kg/m2 can prevent Gestational Diabetes
    1. However, weight loss during pregnancy is not recommended (risk of IUGR and SGA infants)
    2. Black (2022) Women Birth 35(6): 563-9 [PubMed]

XI. Resources

  1. AHRQ Screening and Diagnosing Gestational Diabetes
    1. http://www.ncbi.nlm.nih.gov/books/NBK114844/

XII. References

  1. (2014) Diabetes Care 37(suppl 1): S14-80 [PubMed]
  2. (2013) Obstet Gynecol 122(2 pt 1): 406-16 [PubMed]
  3. (2001) Obstet Gynecol 98:525-38 [PubMed]
  4. Garrison (2015) Am Fam Physician 91(7): 460-7 [PubMed]
  5. Will (2023) Am Fam Physician 108(3): 249-58 [PubMed]

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Ontology: Gestational Diabetes (C0085207)

Definition (MEDLINEPLUS)

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. When you are pregnant, too much glucose is not good for your baby.

About seven out of every 100 pregnant women in the United States get gestational diabetes. Gestational diabetes is diabetes that happens for the first time when a woman is pregnant. It goes away after you have your baby, but it does increase your risk for having diabetes later.

If you already have diabetes before you get pregnant, you need to monitor and control your blood sugar levels during pregnancy.

Most women get a test to check for diabetes during their second trimester of pregnancy. Women at higher risk may get a test earlier.

Either type of diabetes during pregnancy raises the risk of problems for the baby and the mother. To help lower the risks, you should follow your meal plan, exercise, test your blood sugar, and, if needed, take your medicine.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (NCI) Carbohydrate intolerance first diagnosed during pregnancy.(NICHD)
Definition (MSH) Diabetes mellitus induced by PREGNANCY but resolved at the end of pregnancy. It does not include previously diagnosed diabetics who become pregnant (PREGNANCY IN DIABETICS). Gestational diabetes usually develops in late pregnancy when insulin antagonistic hormones peaks leading to INSULIN RESISTANCE; GLUCOSE INTOLERANCE; and HYPERGLYCEMIA.
Definition (CSP) glucose intolerance which onsets during pregnancy; does not include diabetics who become pregnant or women who become lactosuric; after pregnancy, the woman is reclassified as diabetic or not depending on whether glucose intolerance persists.
Concepts Disease or Syndrome (T047)
MSH D016640
ICD10 O24.4
SnomedCT 393568003, 199232003, 237629002, 359964007, 11687002
LNC LA10553-8
English Diabetes Mellitus, Gestational, Diabetes, Gestational, Diabetes, Pregnancy Induced, Diabetes, Pregnancy-Induced, Pregnancy-Induced Diabetes, Diabetes mel aris in pregnancy, GDM - Gestational diab mellit, Gestational Diabetes Mellitus, Diabetes in Pregnancy, Gestational Diabetes, DIABETES, GESTATIONAL, DIABETES PREGN IND, gestational diabetes mellitus (diagnosis), gestational diabetes, gestational diabetes mellitus, Diabetes mellitus gestational, Gestational diabetes mellitus NOS, Diabetes, Gestational [Disease/Finding], pregnancy-induced diabetes, Diabetes;during pregnancy, maternal diabetes, diabetes pregnancy, gdm, pregnancy induced diabetes, diabetes during pregnancy, Diabetes and Pregnancy, Maternal gestational diabetes mellitus (disorder), -- Gestational Diabetes, GDM, Diabetes mellitus arising in pregnancy, GDM - Gestational diabetes mellitus, Gestational diabetes, Gestational diabetes mellitus, Gestational diabetes mellitus (disorder), Maternal gestational diabetes mellitus, Gestational diabetes mellitus, NOS
Dutch zwangerschapsdiabetes mellitus, zwangerschapsdiabetes, Diabetes mellitus ontstaand tijdens zwangerschap, Diabetes, zwangerschaps-, Zwangerschapsdiabetes
German Diabetes mellitus, schwangerschaftsbedingt, schwangerschaftsbedingter Diabetes mellitus, Diabetes mellitus, waehrend der Schwangerschaft auftretend, Diabetes mellitus, Schwangerschafts-, Diabetes, schwangerschaftsbedingter, Diabetes, schwangerschaftsinduzierter, Gestagener Diabetes, Schwangerendiabetes, Schwangerschaftsdiabetes
Portuguese Diabetes mellitus gestacional, Diabetes Induzida por Gravidez, Diabetes gravídica, Diabetes Gestacional, Diabetes Induzida pela Gravidez, Diabetes Mellitus Gestacional
Spanish Diabetes mellitus gestacional, DMG, diabetes gestacional, diabetes mellitus de comienzo en el embarazo, diabetes mellitus del embarazo, diabetes mellitus gestacional (trastorno), diabetes mellitus gestacional, Diabetes gestacional, Diabetes Gestacional, Diabetes Inducida por Embarazo, Diabetes Mellitus Gestacional
Swedish Graviditetsdiabetes
Japanese ﾆﾝｼﾝﾄｳﾆｮｳﾋﾞｮｳ, 妊娠糖尿病, 糖尿病-妊娠, 妊娠性糖尿病
Czech diabetes vyvolaný těhotenstvím, diabetes mellitus gestační, Gestační diabetes mellitus, Gestační diabetes, těhotenský diabetes, gestační diabetes, diabetes gestační, gestační diabetes mellitus, těhotenská cukrovka
Finnish Raskausdiabetes
Russian DIABET SAKHARNYI GESTATSIONNYI, DIABET GESTATSIONNYI, GESTATSIONNYI DIABET, DIABET SAKHARNYI, OBUSLOVLENNYI BEREMENNOST'IU, ГЕСТАЦИОННЫЙ ДИАБЕТ, ДИАБЕТ ГЕСТАЦИОННЫЙ, ДИАБЕТ САХАРНЫЙ ГЕСТАЦИОННЫЙ, ДИАБЕТ САХАРНЫЙ, ОБУСЛОВЛЕННЫЙ БЕРЕМЕННОСТЬЮ
Italian Diabete in gravidanza, Diabete mellito gestazionale, Diabete gestazionale
Korean 임신중 생긴 당뇨병
Croatian DIJABETES, GESTACIJSKI
Polish Cukrzyca wywołana ciążą, Cukrzyca w ciąży, Cukrzyca ciążowa
Hungarian Diabetes mellitus, gestatiós, Gestatiós diabetes, Gestatiós diabetes mellitus
Norwegian Graviditetsdiabetes, Svangerskapsdiabetes, Gestasjonsdiabetes
French Diabète de la grossesse, Diabète sucré de la grossesse, Diabète sucré gestationnel, Diabète gestationnel, Diabète de la gestation, Diabète induit par la grossesse
Derived from the NIH UMLS (Unified Medical Language System)

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