Screening, Diagnosis and Management of Gestational Diabetes Mellitus

Abstract

Gestational diabetes mellitus (GDM) is defined as abnormal glucose tolerance recognized first during pregnancy. Presence of GDM has been associated with obstetric and neonatal complications and has been recognized as a risk factor for future risk of diabetes and obesity in both mother and baby. The factors that play a role in development of GDM, include age, obesity, family history of diabetes, and previous history of GDM. Ethnicity, multi-fetal pregnancies, and presence of polycystic ovaries are some other risk factors for GDM. There are several screening and diagnostic criteria for GDM. The most widely accepted is the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria which recommends a single step 75 g oral glucose tolerance test at 24–28 weeks. To ensure normal glucose levels and reduce mortality and morbidity due to GDM, management of GDM during pregnancy and postpartum follow up are very essential. In this review, we present some key issues related to postpartum testing and have highlighted some strategies to tackle the same. We also present some learnings from the Women in India with GDM Strategy project, which developed a model of care for GDM in resource constrained settings. As part of the implementation of the model of care, several strategies were adopted that led to a 95.8% postpartum follow up of women with GDM.