Gestational Diabetes in Primary Care

Paul Hicks, MD

In This Article


The common course of gestational diabetes is complete resolution in the postpartum period, although it can be several days or weeks before the glucose intolerance completely resolves. Paralleling the drop in cortisol level, human placental lactogen (HPL), and estrogen, the insulin requirement declines to 60% of that needed before delivery.[29] Continuing to check FSBS, either before meals and at bedtime or fasting and postprandially, one can assess the need for continued insulin treatment. Only in rare instances does a woman need insulin on a long-term basis. Usually, if any treatment is required, low-dose oral agents are sufficient. Bear in mind that all the newer oral agents, including Metformin, are excreted in breast milk and have unknown effects on the baby. The American Academy of Pediatrics considers tolbutamide to be compatible with breast-feeding.[54]

In addition to the immediate management, one must consider the possibility of future development of Type II DM. This risk has been estimated at 30%-50%[1] (the risk of GDM in a future pregnancy is estimated at 50%-70%).[47,55,56] Therefore, it is recommended that at the 6-week postpartum visit women have a 2-hour, 75-g GTT. The diagnosis of diabetes is made if fasting plasma glucose is ≥ 126 mg/dL or if the 2- hour level is ≥ 200mg/dL ( Table 6 ). In addition, a random plasma glucose level of ≥ 200 mg/dL is diagnostic of diabetes and requires no confirmatory testing.[13] If the result of the 2-hour GTT is negative, repeat testing every 3 years may be considered.[15] Education of the new mother is imperative. It is prudent, given the risk of developing DM, that she be encouraged to continue following a healthy diet appropriate for individuals with diabetes and to participate in regular exercise.

There are no standard guidelines for the follow-up of children from GDM pregnancies. It is known that infants of mothers with pregestational diabetes are at increased risk for obesity and being overweight.[57,58,59] There is evidence of a similarly increased risk in children born to mothers with GDM.[60]


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