Maternal Diabetes

Treatment of GDM

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, and its prevalence has been steadily increasing. GDM increases the risk of adverse outcomes for both the patient and their child during the prenatal and perinatal periods.

The primary goal of GDM treatment is to reduce risks to the pregnant patient and their child. Effective glycemic management during pregnancy is essential to avoid complications such as congenital anomalies, preeclampsia, macrosomia and preterm birth. Behavioral management—including nutrition therapy and physical activity—is recommended as the initial approach to achieve glycemic targets, and it may be sufficient for many patients with GDM. However, if health behavior changes alone do not achieve glycemic targets in GDM, pharmacologic therapy is recommended, and insulin is generally the first-line pharmacologic therapy. Treating GDM with behavioral management and medication has been shown to improve outcomes, including decreased rates of preeclampsia, shoulder dystocia and macrosomia.

The Role of Glucose Monitoring in GDM

Multiple professional societies, including the ADA and the American Association of Clinical Endocrinology, recommend fasting and postprandial glucose monitoring and endorse specific glycemic targets during pregnancy. Glucose monitoring can be helpful to support health behavior changes and guide medication adjustments.

Emerging evidence supports the American Diabetes Association's recommendation that continuous glucose monitoring (CGM)—which is recommended as standard therapy for people with diabetes who are treated with insulin—may be beneficial for patients with GDM.

AAFP has produced an anticipatory guidance resource detailing care for patients with a GDM diagnosis, as well as CGM options for pregnant and postpartum patients.

_{The content on this page was independently developed by the AAFP with support from Dexcom, Inc.}