Initial Treatment for Gestational Diabetes

Lifestyle Interventions

The American Diabetes Association recommends that an individualized nutrition plan should be developed between the patient and a registered dietitian familiar with GDM management, providing adequate calories to promote fetal/neonatal and maternal health, achieve glycemic goals, and promote appropriate gestational weight gain 1, 2, 3, 4
Dietary recommendations for GDM management include a minimum of 175 g of carbohydrate daily, 71 g of protein daily, and 28 g of fiber daily, with an emphasis on monounsaturated and polyunsaturated fats while limiting saturated fats and avoiding trans fats 1, 2, 4
Regular physical activity should be incorporated into the treatment plan, with generally healthy pregnant women aiming for at least 150 minutes of moderate-intensity aerobic activity weekly, preferably spread throughout the week 3, 4

The American College of Obstetricians and Gynecologists recommends self-monitoring of blood glucose with targets of fasting < 95 mg/dL, one-hour postprandial < 140 mg/dL, and two-hour postprandial < 120 mg/dL 2, 5

The American Diabetes Association recommends insulin as the preferred medication for treating hyperglycemia in GDM, as it does not cross the placenta to a measurable extent, and is recommended as the first-line pharmacological agent in the United States 1, 5, 6
Metformin and glyburide should not be used as first-line agents, as both cross the placenta to the fetus, and have been shown to fail to provide adequate glycemic control in 23% and 25-28% of women with GDM, respectively 1, 6

Failure to recognize that most women (70-85%) can achieve glycemic targets with lifestyle modifications alone may lead to delayed initiation of pharmacological therapy when necessary 1, 2
Inadequate monitoring of blood glucose levels to assess treatment effectiveness can lead to poor outcomes, and women with greater initial degrees of hyperglycemia may require earlier initiation of pharmacological therapy 2, 4, 5

Telehealth visits for pregnant people with GDM have been shown to improve outcomes compared with standard in-person care, reducing incidences of cesarean delivery, neonatal hypoglycemia, and other complications 4