Gestational diabetes mellitus (GDM) complicates a substantial number of pregnancies. There is consensus that in patients of GDM, excellent
blood glucose control, with diet and, when necessary, oral
hypoglycemics and
insulin results in improved perinatal outcomes, and appreciably reduces the probability of serious neonatal morbidity compared with routine
prenatal care. Goals of metabolic management of a pregnancy complicated with GDM have to balance the needs of a healthy pregnancy with the requirements to control
glucose level.
Medical nutrition therapy is the cornerstone of
therapy for women with GDM. Surveillance with daily self-monitoring of
blood glucose has been found to help guide management in a much better way than
blood glucose checking in labs and clinics, which tends to be less frequent. Historically,
insulin has been the therapeutic agent of choice for controlling
hyperglycemia in pregnant women. However, difficulty in medication administration with multiple daily
injections, potential for
hypoglycemia, and increase in appetite and weight make this therapeutic option cumbersome for many pregnant patients. Use of oral hypogycemic agents (OHAs) in pregnancy has opened new vistas for GDM management. At present, there is a growing acceptance of
glyburide (
glibenclamide) use as the primary
therapy for GDM.
Glyburide and
metformin have been found to be safe, effective and economical for the treatment of
gestational diabetes.
Insulin, however, still has an important role to play in GDM. GDM is a window of opportunity, which needs to be seized, for prevention of diabetes in future life. Goal of our educational programs should be not only to improve pregnancy outcomes but also to promote healthy lifestyle changes for the mother that will last long after delivery. Team effort on part of obstetricians and endocrinologists is required to make "the diabetes capital of the world" into "the diabetes care capital of the world".