Disclosure of risks related to: Significant glucose intolerance
Pre-gestational diabetes mellitus (Type 1 or Type 2) affects approximately 1% of pregnancies, with an incidence rising with the incidence of type 2 diabetes in younger adults. Gestational diabetes is diagnosed in 5-7% of pregnancies.
Risk factors for GDM: occurs more commonly in women with a family history of diabetes, prior personal history of glucose intolerance including prior gestational diabetes, obesity, and maternal age over 25.
• Antepartum hospitalization
• Induction of labor
• Cesarean dellivery
• Uncontrolled diabetes may result in:
o kidney damage
o retinopathy resulting in vision loss
o peripheral nerve damage.
• Even when controlled, pre-gestational diabetes is associated with an increased risk of miscarriage and major congenital anomalies. This risk rises with poorer control around the time of conception.
• Throughout pregnancy, diabetes is associated with increased risks of:
o hypertensive disorders
o large for gestational age babies
o abnormal progression of labor
o cesarean delivery
o shoulder dystocia with resultant brachial plexus injury
• Due to these risks, more frequent ultrasound examinations and antepartum testing of fetal well-being may be indicated.
• In the newborn period
Timing of delivery:
• Pre-gestational diabetes, and uncontrolled gestational diabetes: between 37 and 39 weeks, individualized
• Controlled gestational diabetes: between 39 and 41 weeks, individualized
Pre-gestational Diabetes Mellitus. American College of Obstetricians and Gynecologists, Practice Bulletin 60, March 2005.
Gestational Diabetes Mellitus. American College of Obstetricians and Gynecologists, Practice Bulletin 137, August 2013.
Landon MB, Gabbe SG. Gestational Diabetes Mellitus. Obstet Gynecol 2011;118:1379-93.