Management of gestational diabetes mellitus to optimize outcomes

Gestational diabetes mellitus (GDM) is a very common medical complication during gestation. It is associated with increased maternal, fetal, and neonatal adverse outcomes, principally macrosomia. Tight glycemic control is the cornerstone for improving pregnancy morbidity. Accordingly, glucose monitoring and continuous treatment titration to reach glucose targets are of paramount importance. Key treatment options for optimizing GDM outcomes are medical nutrition therapy, physical activity, insulin, metformin, and glyburide. Importantly, the obstetric follow-up includes the detection of large for gestational age and macrosomia, determination of delivery timing and mode. Simultaneously, potential stillbirth and neonatal asphyxia should be avoided. A 75-g oral glucose tolerance test at 4-12 weeks after delivery is recommended for all women with GDM to screen for type 2 diabetes.