Gestational Diabetes[GDM] is present in two to three percent of all pregnancies are complicated by and 15% of patients require insulin during pregnancy [Class A2].

Diabetes will often be diet controlled [Class A1] but up to 60% of patients with GDM will become overtly diabetic 5-10 years postpartum. Thus, patients should be screened at 6 weeks after delivery and yearly thereafter.

Diabetes Risk Factors Include:

  • Obesity *
  • Positive family history * [First degree relative]
  • History of glucose intolerance *
  • History of a macrosomic baby, stillbirth or congenital
  • anomaly
  • Hispanic, African American, Native American or Pacific Islands ethnicity
  • Advanced maternal age

* Patients with these risk factors should be screened at the 1st prenatal visit and later at 24-28 weeks

Pregestational Diabetes

Less than 10% of all women with diabetes in pregnancy have pregestational diabetes. Less than 0.5% of women with diabetes in the US receive preconception counseling and their infants are at significant risk for congenital anomalies.

Glycemic control before and during pregnancy may reduce this risk. Patients using oral hypoglycemics should switch to insulin preconception and ACE inhibitors should be discontinued preconception.

Services Provided by DM in Pregnancy Program:

  • Preconception counseling & management 
  • Nutritional counseling by certified perinatal dietitian
  • Diabetic teaching by certified diabetic educators including: risks in pregnancy, glucometer use, injection and insulin administration techniques and exercise counseling
  • Perinatal consultation regarding ante-, intra- and/or postpartum care for women with diabetes
  • Ultrasound services for fetal morphology and, if needed, fetal echocardiography 
  • Support group meetings for patients and their significant others
  • Services available range from consultation only, co-management, or assumption of total obstetrical and diabetic care


Screening for Gestational Diabetes

1° Post-Glucola [50gm] test at
24-28 weeks of pregnancy

Abnormal 1° PG
[ > 140 mg/dl ] *

3° Glucose Tolerance Test [100gm]

Abnormal 3° OGTT if > 2 values
meet or exceed limits below **

Fasting: > 95 mg/dl
1 hour: > 180
2 hour: > 155
3 hour: > 140

If despite diet therapy:
Fasting Blood Sugar > 95 and/or
1-2 hr postprandial BS > 120
will require insulin treatment


* If 1° PG > 190 no need for 3°OGTT ==> 
FBS and 1° postprandial instead
** ADA Clinical practice recommendations & 4th International Workshop on GDM 1998