- Click here for explanation of classification scheme.

To discuss the following 4 panels:

• Diagnosis and Prevalence
• Perinatal Implications
• Therapeutic Interventions during Pregnancy
• Long-Range Implications and Management after Pregnancy

None specifically mentioned.

Not applicable.

Recruitment

The Fourth International Workshop-Conference on Gestational Diabetes Mellitus (GDM) was convened under the sponsorship of the American Diabetes Association. The meeting provided a forum for review of new information concerning GDM in the areas of diagnosis and prevalence, perinatal and long-range implications for the mother and her offspring and management strategies.The invited lectures and discussions and their posters submitted by participants culminated in detailed deliberations by four panels. The edited reports of the four panels were synthesized into this report.

Design

Consensus Report

Blinding used (if applicable):  Not applicable

Intervention (if applicable): Not applicable

Statistical Analysis

Not applicable.

Timing of Measurements

Not applicable.

Dependent Variables:

Not applicable.

Independent Variables:

Not applicable.

Control Variables:

Not applicable.

 

Initial N:  Expert Panel convened for recommendations

Attrition (final N):  not applicable

Age:  not applicable 

Ethnicity:  not applicable

Other relevant demographics:

Anthropometrics: 

Location:  Chicago, Illinois

Diagnosis and Prevalence

GDM is defined as carbohydrate intolerance of vaying degrees of severity with onset or first recognition during pregnancy.

Risk assessment for GDM should be ascertained at the first prenatal visit. Women should be grouped into low, average and high risk categories with specific recommendations given for each group.

Perinatal Implications

The primary perinatal concern in GDM remains excessive fetal growth which must be defined relative to gestational age and ethnic group of the infant.

Therapeutic Interventions during Pregnancy

The primary goal of metabolic management is the prevention of adverse perinatal outcomes. The primary management strategy is to maintain maternal capillary blood glucose levels at or below the following levels:

fasting < 95mg/dl

1 hour post prandial < 140 mg/dl

2 hour post prandial < 120 mg/dl

Medical nutrition therapy is the cornerstone of treatment for GDM. The nutritional prescription should fufill minimum requirements for pregnancy and should be culturally appropriate. Expected weight gain will vary according to pre-pregancy body weight. Self-monitoring of blood glucose appears to be superior to less frequent glucose monitoring in the clinic. Glucose monitoring should include postprandial testing. Patients who fail to chieve or maintain glycemic goals or who show signs of excessive fetal growth should receive treatment with insulin in addition to standard nutritional management.

Regular aerobic exercise may be used as an adjunct to nutritional therapy to improve maternal glycemia.

Maternal hyperglycemia during labor should be avoided because it may potentiate the risk of neonatal hypoglycemia and accentuate the rise in lactate and decline in pH that normally accompanies any fetal hypoxia.

The risk of hypertensive disorders is increased approximately 2 fold in women with GDM compared with non GDM.

Long-Range Implications and Management after Pregnancy

GDM is associated with a high lifetime risk for diabetes in the mother. The risk of progression to diabetes within 5 years of GDM is related to gestational age at diagnosis, the severity of GDM at diagnosis, the level of glycemia at the first postpartum assessment, impairment of Beta cell function, obestiy, and further pregnancy.

All subsequent pregnancies carry a risk for GDM or pre-GDM. Women with prior GDM need to participate in aprogram for planned pregnancies.

By the time of puberty, the offspring of women with GDM have an increased risk of obesity and abnormal glucose tolerance. Measures aimed at reducing or preventing obesity by modification of lifestyle may decrease this risk.

The diagnosis of GDM provides an important opportunity to identify women at high risk for future diabetes. This opportunity should be used to develop intervention strategies that can be tested in clinical trials aimed at delaying or preventing ithe onsent of diabetes and its long-term consequence.

University/Hospital:

Northwestern University Medical School, Brown University School of Medicine and the Women and Infant's Hospital of Rhode Island

Consensus report from the experts in the field of GDM. No discussion of validity and reliability of the studies included or what might have been excluded.