See related U. 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, g.
It is evident that GDM defined in this way will include patients with undiagnosed preexisting type 2 diabetes mellitus type 2 DM as well as those with diabetes with first onset during pregnancy. Normal pregnancy is associated with insulin resistance similar to that found in type 2 DM. The reduction in whole-body insulin action becomes apparent in the second trimester, and insulin sensitivity declines progressively to term 2, 3. After delivery, whole-body insulin action returns rapidly to normal 4.
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