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Interconception care for women with prior gestational diabetes mellitus.

Abstract
The diagnosis of gestational diabetes mellitus (GDM) signals greater pregnancy risk but also increased lifelong risk of developing diabetes and cardiovascular disease. In women with GDM, insulin resistance exceeds that observed in normal pregnancy and to varying degrees may persist or worsen after birth. Therefore, during postpartum and interconception periods, women with a history of GDM must be monitored for manifestations of increasing insulin resistance, hyperglycemia, dyslipidemia, hypertension, and increased adiposity. Care of women with prior GDM in the postpartum and interconception periods affords clinicians a unique opportunity for targeted screening and health promotion. The objective of this review was to synthesize evidence related to interconception care for women following a pregnancy complicated by GDM and to suggest principles of care: 1) case finding and multiple patient/clinician reminders for women with prior GDM are necessary so that screening occurs in the postpartum through interconception periods; 2) monitoring of metabolic (glucose) and cardiovascular risk (lipids, blood pressure, adiposity) should occur at regular intervals and more often in women with additional risk factors such as insulin use during pregnancy, early diagnosis of GDM, obesity, prediabetes, and dyslipidemia; 3) breastfeeding and use of long-term contraception should be encouraged; and 4) lifestyle modifications that are effective in preventing and delaying disease should be encouraged.
AuthorsRuth T Mielke, Deborah Kaiser, Rhonda Centuolo
JournalJournal of midwifery & women's health (J Midwifery Womens Health) 2013 May-Jun Vol. 58 Issue 3 Pg. 303-12 ISSN: 1542-2011 [Electronic] United States
PMID23631462 (Publication Type: Journal Article, Review)
Copyright© 2013 by the American College of Nurse-Midwives.
Chemical References
  • Blood Glucose
  • Insulin
  • Lipids
Topics
  • Blood Glucose (metabolism)
  • Blood Pressure
  • Breast Feeding
  • Cardiovascular Diseases (etiology)
  • Contraception
  • Diabetes Mellitus, Type 2 (blood, etiology)
  • Diabetes, Gestational (blood, physiopathology)
  • Female
  • Health Promotion
  • Humans
  • Insulin (blood)
  • Insulin Resistance
  • Life Style
  • Lipids (blood)
  • Mass Screening
  • Monitoring, Physiologic
  • Obesity (blood, complications)
  • Postpartum Period
  • Preconception Care
  • Prediabetic State (complications)
  • Pregnancy
  • Risk Factors
  • Standard of Care

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