Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset at or first detected during pregnancy.  Gestation Diabetes must be treated because it is associated with the following complications for both mother and baby

• Difficult natural delivery
• Increased rate of Caesarian
• Macrosomia LGA
• Increased birth weight
• Fetal shoulder dystocia
• Neonatal hypoglycaemia
• Diabetic Retinopathy
• Kidney damage
• Hypertension

Management of GDM includes pre-conception care, screening & diagnosis, antenatal care & treatment and postpartum care. 

Pre-conception Care

Before conceiving, women with pre-existing diabetes (or at risk) are advised to reduce weight (if they are overweight), participate in exercises for at least 150 minutes per week, maintain good blood pressure (below 130/80 mmHg), keep HbA1c less than 6.5% and review their medications with their gynae doctor.  They should also start folic acid supplement (5 mg daily) around 3 months BEFORE getting pregnant.  Try to connect with a dietician to plan your dietary requirements during your pregnancy.

Ante-Natal Care

During your pregnancy, you will have several ultrasound scans for your baby

• Dating scan
• 12 weeks (1st trimester screening)
• 20 weeks (detect fetal and heart abnormalities)
• 28 / 32 / 36 weeks (or more if required) to monitor fetal growth and amniotic fluid volume.  The rate of growth needs to be assessed to facilitate decisions involving treatment as well as timing and mode of delivery of your baby

Treatment for Gestational Diabetes

During your pregnancy, your doctor will monitor your blood tests to ensure you keep within the Glycemic Targets shown below;

Glycemic Targets

• HbA1c less than 7% (ideally should be 6.5% or less)
• FBG 5.3 mmol/l or less
• BG 7.8 mmol/l or less 1 hour post-prandial
• BG 6.4 mmol/l or less 2 hours post-prandial

Conservative Treatment (successful in 50% by modifying lifestyle)

• Food modification (try to maintain 3 meals plus 2-3 snacks, avoid high glycemic foods at breakfast, limit carbohydrates to 35-45% of total intake and fats less than 30% of total intake)
• Avoid refined or processed foods
• Aim for 30 minutes of gentle exercise daily for at least 5 days a week
• Aim to eat within your recommended calorie intake to prevent excess weight gain
• Try some gentle sports include walking, pregnancy yoga, tai chi, swimming, aqua aerobics and antenatal classes

Calorie Recommended Intake for appropriate Gestational Weight Gain (GWG)

Pre-Pregnancy BMI Category	Calories per kg weight per day	Total Weight Gain (range in kg)
Low (BMI < 18.5)	36-40	12.5-18.0
Normal (BMI 18.5-24.9)	30	11.5-16.0
Overweight (BMI 25-29.9)	24	7.0-11.5
Obese (BMI >29.9)	12	5.0-9.0

Medication

Medication is usually recommended if the FBG is more than 7 mmol/l DESPITE modifying both your diet and changing your lifestyle as described above. Your doctor will usually start with Metformin and then Insulin (or add Glibenclamide if you are not keen on insulin). Do discuss the treatment options with your doctor because every individual case is different.

Postpartum Care (after delivery)

• Women with pre-existing diabetes may need to change their medication and have blood glucose monitored carefully because there is a risk of hypoglycaemia during breast feeding
• Women with GDM should be able to discontinue their medication after delivery

Women with GDM are still recommended to screen for Diabetes (even if they do not need to be on diabetic medication after delivery) because there is a risk of diabetes developing later in life

• FBG (and OGTT if necessary) at 6-13 weeks after delivery
• HbA1c after 13 weeks
• Yearly screening diabetic blood tests thereafter (even if all the tests above are normal)

Discuss with your gynae doctor, endocrinologist and dietician about your treatment options for your Gestational Diabetes

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