Gestational Diabetes Mellitus

Gestational DM is diagnosed as previously described. Dietary therapy to minimize wide fluctuations in blood glucose is of paramount importance. Pregnant women without DM maintain plasma glucose concentrations between 50 and 130 mg/dL. If fasting plasma glucose is>105 mg/dL, or 1-hour postprandial plasma glucose levels are>155 mg/dL, or if 2-hour postprandial plasma glucose levels are >130 mg/dL, insulin therapy is usually begun. One shot of NPH or a mixture of NPH and regular insulin in a 2:1 ratio given before breakfast may be adequate to reach glucose targets. Adequate control of blood glucose was achieved as compared to traditional insulin therapy, with less hypoglycemia in the glyburide group. No evidence of any difference in complications, specifically cord-serum insulin concentrations, incidence of macrosomia, cesarean delivery, or neonatal hypoglycemia between regimens were noted. Glyburide was not detected in the cord serum of any infant. As the study limited enrollment beyond 11 weeks’ gestation, no conclusions regarding teratogenicity can be made from this study. 12 Patients with gestational DM should be evaluated 6 weeks after delivery to ensure that normal glucose tolerance has returned. Because these patients’ long-term risk for the development of DM is considerable, periodic assessment after that is warranted (Dipiro, et all, 2005).

In addition to insulin and glyburide, there are other drugs that are known to improve diabetic conditions getational that is troglitazone. This drug was reported capable of lowering blood sugar levels in patients with gestational diabetes by 55%, but this agent is no longer available (DeFronzo, et all, 2011). <Hg>


source : 
DeFronzo, et all, 2011, Pioglitazone for Diabetes Prevention in Impaired Glucose Tolerance,  N Engl J Med 2011;364:1104-15.
Dipiro, et all, 2005, PHARMACOTHERAPY A Pathophysiologic Approach, 6 Ed, McGRAW-HILL


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