Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is a state of carbohydrate intolerance that develops or is first recognized during pregnancy. In some women, ß-cell production of insulin cannot keep pace with the resistance to insulin produced by the diabetogenic hormones from the placenta. The prevalence of GDM in the United States is estimated to be 5-7% and increases with the increasing prevalence of type 2 diabetes mellitus. GDM is the most common medical complication of pregnancy and is clearly linked to maternal and fetal complications including fetal macrosomia, operative delivery, birth trauma, preeclampsia and hypertensive disorders, and metabolic complications such as hypoglycemia, hypocalcemia, hyperbilirubinemia, prematurity, and perinatal mortality. This chapter reviews different diagnostic screening strategies, therapeutic modalities and antepartum and postpartum considerations when caring for patients with GDM.