ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus

doi:10.1097/aog.0000000000002501

Cited by 1,143 publications

(473 citation statements)

References 85 publications

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“…Weight gain recommendations are based on the Institute of Medicine’s guidelines for weight gain during pregnancy, which account for maternal body mass index but are unchanged by a diagnosis of diabetes in pregnancy 11. Exercise may improve glucose tolerance during pregnancy in women with gestational diabetes, and the ACOG and ADA have endorsed exercise as a helpful adjunct therapy in the treatment of diabetes 134…”

Section: Lifestyle Modificationsmentioning

confidence: 99%

“…The ACOG and the Endocrine Society support a low carbohydrate diet, whereas the ADA and the Fifth International Workshop on Gestational Diabetes have withdrawn specific recommendations on diet or macronutrients for women with diabetes because of the absence of adequate RCTs 341314. A diet low in simple carbohydrates (33-40% of calories) is thought to limit postprandial glucose excursions and the associated risk of excessive fetal growth 15.…”

Section: Lifestyle Modificationsmentioning

confidence: 99%

“…Fasting and postprandial blood glucose monitoring is recommended in all type of diabetes, and preprandial testing is also recommended for pregnant women with pre-existing diabetes who are using insulin pumps or basal-bolus therapy 13410. Although HbA 1c assessment is less burdensome than frequent daily testing, it is considered a secondary measure of glycemic control in pregnancy because A 1c concentrations fall during normal pregnancy owing to red blood cell turnover and HbA 1c does not reflect variability in glucose concentration 1310…”

Section: Glucose Monitoringmentioning

confidence: 99%

“…Insulin is the preferred treatment for pregestational diabetes in pregnancy, and several professional societies endorse it as a first line therapy in gestational diabetes 34. The type of insulin, timing of administration, and frequency are based on individual glycemic patterns.…”

Section: Insulinmentioning

confidence: 99%

“…Diabetes affects 6-9% of pregnancies with approximately 99% of women having gestational diabetes, 0.5% having type 2 diabetes, and 0.3% having type 1 diabetes 1234. In particular, the prevalence of gestational diabetes varies by population and diagnostic criteria 5.…”

Section: Introductionmentioning

confidence: 99%

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Novel therapies for diabetes mellitus in pregnancy

Feghali

Scifres

2018

BMJ

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Diabetes is a common complication of pregnancy, and the prevalence of all types of the disease is increasing worldwide. Diabetes in pregnancy is associated with short term and long term adverse effects for mother and child. The goal of treatment of diabetes in pregnancy is to minimize maternal and fetal adverse events related to hyperglycemia. Treatment options vary by type of diabetes, from a focus on lifestyle modifications in gestational diabetes to continuous glucose monitoring and insulin pumps in pregestational diabetes. Nevertheless, given the commonality of hyperglycemia, considerable overlap exists in the treatment of different types of diabetes in pregnancy. Also, despite ongoing research on treatment of diabetes in pregnancy for decades, changes in the characteristics of the patient population have highlighted the limited effectiveness of different therapies. Specifically, despite the co-occurrence of obesity and diabetes, treatment recommendations including glycemic targets are not altered in such cases and a single optimal treatment strategy for each type of diabetes in pregnancy does not seem to exist. Rather, the approach to treating pregnant women with diabetes likely needs to be individualized to maximize the short term and long term health of mother and child. This article will review recent clinical studies to summarize established treatment strategies and introduce novel therapies for diabetes in pregnancy.

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Section: Lifestyle Modificationsmentioning

confidence: 99%

Section: Lifestyle Modificationsmentioning

confidence: 99%

Section: Glucose Monitoringmentioning

confidence: 99%

Section: Insulinmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Novel therapies for diabetes mellitus in pregnancy

Feghali

Scifres

2018

BMJ

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Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes

Sénat

Affres

Letourneau

et al. 2018

JAMA

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Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019

Shah

Wang

Freaney

et al. 2021

JAMA

163

140

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OBJECTIVE To determine whether rates of gestational diabetes among individuals at first live birth changed from 2011 to 2019 and how these rates differ by race and ethnicity in the US.DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis using National Center for Health Statistics data for 12 610 235 individuals aged 15 to 44 years with singleton first live births from 2011 to 2019 in the US.EXPOSURES Gestational diabetes data stratified by the following race and ethnicity groups: Hispanic/Latina (including Central and South American, Cuban, Mexican, and Puerto Rican); non-Hispanic Asian/Pacific Islander (including Asian Indian, Chinese, Filipina, Japanese, Korean, and Vietnamese); non-Hispanic Black; and non-Hispanic White. MAIN OUTCOMES AND MEASURESThe primary outcomes were age-standardized rates of gestational diabetes (per 1000 live births) and respective mean annual percent change and rate ratios (RRs) of gestational diabetes in non-Hispanic Asian/Pacific Islander (overall and in subgroups), non-Hispanic Black, and Hispanic/Latina (overall and in subgroups) individuals relative to non-Hispanic White individuals (referent group). RESULTS Among the 12 610 235 included individuals (mean [SD] age, 26.3 [5.8] years), the overall age-standardized gestational diabetes rate significantly increased from 47.6 (95% CI, 47.1-48.0) to 63.5 (95% CI, 63.1-64.0) per 1000 live births from 2011 to 2019, a mean annual percent change of 3.7% (95% CI, 2.8%-4.6%) per year. Of the 12 610 235 participants, 21% were Hispanic/Latina (2019 gestational diabetes rate, 66.6 [95% CI, 65.6-67.7]; RR, 1.15 [95% CI, 1.13-1.18]), 8% were non-Hispanic Asian/Pacific Islander (2019 gestational diabetes rate, 102.7 [95% CI, 100.7-104.7]; RR, 1.78 [95% CI, 1.74-1.82]), 14% were non-Hispanic Black (2019 gestational diabetes rate, 55.7 [95% CI, 54.5-57.0]; RR, 0.97 [95% CI, 0.94-0.99]), and 56% were non-Hispanic White (2019 gestational diabetes rate, 57.7 [95% CI, 57.2-58.3]; referent group). Gestational diabetes rates were highest in Asian Indian participants (2019 gestational diabetes rate, 129.1 [95% CI, 100.7-104.7]; RR, 2.24 [95% CI,). Among Hispanic/Latina participants, gestational diabetes rates were highest among Puerto Rican individuals (2019 gestational diabetes rate, 75.8 [95% CI, 71.8-79.9]; RR, 1.31 [95% CI, 1.24-1.39]). Gestational diabetes rates increased among all race and ethnicity subgroups and across all age groups.CONCLUSIONS AND RELEVANCE Among individuals with a singleton first live birth in the US from 2011 to 2019, rates of gestational diabetes increased across all racial and ethnic subgroups. Differences in absolute gestational diabetes rates were observed across race and ethnicity subgroups.

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ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus

Cited by 1,143 publications

References 85 publications

Novel therapies for diabetes mellitus in pregnancy

Novel therapies for diabetes mellitus in pregnancy

Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes

Trends in Gestational Diabetes at First Live Birth by Race and Ethnicity in the US, 2011-2019

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