Gestational diabetes medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Specific treatment will be determined by the physician(s) based on:
- age, overall health, and medical history
- extent of the disease
- tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- opinion or preference [1]
Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:
- special diet
- exercise
- daily blood glucose monitoring
- insulin injections
- there is evidence that certain oral glycemic agents such as glyburide are safe in pregnancy, or at least, are significantly less dangerous to the developing fetus than poorly controlled diabetes. However, few studies have been performed as of this time.
Insulin therapy
Insulin therapy in patients with GDM is based on pre-pregnancy BMI. Women who are lean before conception, the insulin dose requirement is 0.8U/Kg and for the obese women it is 0.9-1U/kg. There is insufficient evidence available regarding the safety of the insulin analogues, Aspart and Lispro hence regular human insulin is the treatment of choice and can be combined with intermediate or basal insulin such as NPH/ lente/ ultralente. There isn’t enough data regarding the safety of the long acting insulin glargine in pregnancy.
Oral Hypoglycemics
The use of oral medications is considered when diet and exercise do not adequately control blood sugars. Some studies have recently evaluated the safety and efficacy of Glyburide (sulphonylurea) after the first trimester for treatment of GDM. The older sulphonylureas were not recommended for use in pregnancy because they crossed the placenta. Glyburide only minimally crosses the placenta. It has been shown that it is as effective as insulin, more cost effective than insulin and safe for use in pregnancy. Both American Diabetic Association [ADA] and American college of Obstetricians and Gynecologists [ACOG] await more research related to the effect of glyburide on maternal and perinatal outcomes before approving its use. There is inadequate data in regards to the safety and efficacy of other oral antidiabetic medications such as Metformin, thiazolidinediones and Acarbose.
Postnatal Care
Approximately 50% women will develop type 2 diabetes within 5 years of development of gestational diabetes. The greatest risk factor for early-onset type 2 diabetes after pregnancy was early gestational age at the time of diagnosis and elevated fasting glucose. The greatest long term risk factor was maternal obesity. Hence these women should be screened by a 75 gm 2 hour oral glucose tolerance test. The children of women diagnosed with GDM are at increased risk of obesity and abnormal glucose metabolism during childhood, adolescence and adulthood. One of the mechanisms thought to be contributing to the long term complications in these babies is ‘early onset hyperinsulinimia’. Hence these children need close follow up.
References
- ↑ "Gestational Diabetes". An overview of gestational diabetes, including risk factors and treatment. University of Maryland Medicine. 2003. Retrieved 2006-11-29. Unknown parameter
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