AHRQ Effective Health Care Program - Summary Guides

Gestational Diabetes: Caring for Women During and After Pregnancy
Clinician Summary Guide published 5 Aug 2009

Clinical Bottom Line
Insulin and Oral Hypoglycemic Medications
Delivery: Timing and Mode
Followup
Considerations
Resource for Patients
Source

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1. Introduction
This guide summarizes clinical evidence about prenatal treatment and delivery management for women with gestational diabetes. It also summarizes evidence about followup for the development of type 2 diabetes among women who have had gestational diabetes. There are very few high-quality studies focusing on the treatment and appropriate followup of gestational diabetes. Many of the questions that surround these clinical issues have only a limited evidence base. This guide does not cover the general care of women with type 1 or type 2 diabetes during pregnancy. It also does not cover screening for gestational diabetes or evidence about diet and exercise in the management of gestational diabetes.

Clinical IssueApproximately 7 percent of pregnancies in the United States are complicated by gestational diabetes. Gestational diabetes can lead to neonatal hypoglycemia, respiratory distress syndrome, and fetal macrosomia. Larger infants have increased rates of birth trauma, shoulder dystocia, and cesarean delivery. Current guidelines recommend adequate glycemic control as a strategy to decrease these maternal and fetal complications. Most women who have gestational diabetes can successfully control their blood sugar with diet and exercise. However, some will need oral diabetes medication or insulin.

Gestational diabetes is not just a complication of pregnancy. It is a risk factor for type 2 diabetes. While only about 5 percent of women who have gestational diabetes develop type 2 diabetes within 6 months of delivery, about 60 percent will develop type 2 diabetes within 10 years. (See Figure 1).

Several organizations recommend testing women with a history of gestational diabetes for type 2 diabetes at a postpartum visit and then following them over time.

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AHRQ Effective Health Care Program - Summary Guides