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Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists
Committee on Practice Bulletins—Obstetrics with the assistance of Aaron B. Caughey, MD, PhD, and Mark Turrentine, MD.
INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect a limited, focused change to clarify and pro-
vide additional information on the pharmacologic treatment of gestational diabetes mellitus.
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Refer for diabetes management Consider referral for management Assess glycemic status every 1–3 years
Weight loss and physical activity Weight loss and physical activity
counseling as needed counseling as needed
Consider metformin if combined
impaired fasting glucose and IGT
Medical nutrition therapy
Yearly assessment of glycemic status
Figure 1. Management of postpartum screening results. Abbreviations: FPG, fasting plasma glucose; OGTT, oral glucose tolerance
test; IGT, impaired glucose tolerance. ^
benefit from ongoing intensive medical therapy. The The following recommendations and conclusions
ADA and ACOG recommend repeat testing every are based on limited or inconsistent scientific
1–3 years for women who had a pregnancy affected by evidence (Level B):
GDM and normal postpartum screening test results (19).
For women who may have subsequent pregnan- All pregnant women should be screened for GDM
cies, screening more frequently between pregnancies with a laboratory-based screening test(s) using
can detect abnormal glucose metabolism before fer- blood glucose levels.
tilization and provides an opportunity to ensure pre- In women who decline insulin therapy or who the
pregnancy glucose control (109). Women should be obstetricians or other obstetric care providers
encouraged to discuss their GDM history and need believe will be unable to safely administer insulin,
for screening with their obstetricians or obstetric care or for women who cannot afford insulin, metformin
providers. is a reasonable alternative choice.
Glyburide treatment should not be recommended as
Summary of a first-choice pharmacologic treatment because, in
Recommendations and most studies, it does not yield equivalent outcomes
to insulin.
Conclusions Health care providers should counsel women of the
The following recommendations and conclusions limitations in safety data when prescribing oral
are based on good and consistent scientific agents to women with GDM.
evidence (Level A): Women with GDM should be counseled regarding
Women in whom GDM is diagnosed should receive the risks and benefits of a scheduled cesarean deliv-
nutrition and exercise counseling, and when this ery when the estimated fetal weight is 4,500 g or
fails to adequately control glucose levels, medica- more.
tion should be used for maternal and fetal benefit.
When pharmacologic treatment of GDM is indicat- The following recommendations and conclusions
ed, insulin is considered the preferred treatment for are based primarily on consensus and expert
diabetes in pregnancy. opinion (Level C):
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This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is vol-
untary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is
not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reason-
able judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in
knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not
reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.
While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reli-
ability, or otherwise, either express or implied. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person.
Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including
direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.