Treatment Of Gestational Diabetes Mellitus

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Treatment of gestational diabetes mellitus, whether using insulin, oral diabetes medications, or another means, reduced maternal, fetal, and neonatal risks associated with the disease. When treating GDM, the goal is to bring the patient’s blood glucose levels down to the same levels as those of pregnant women without GDM. Current therapeutic targets are: fasting blood glucose ≤95 mg/dL, 1-hour postprandial <140 mg/dL, and <120 mg/dL for 2-hour postprandial blood glucose concentrations (Hernandez, et al., 2011). However, just as there is no universal agreement on screening and diagnosis strategies, there is no universal agreement on the optimal therapeutic targets in the treatment of GDM. Blood glucose concentrations during a normal pregnancy are actually lower than these targets, and in fact, rarely exceed 100 mg/dL in the absence of obesity. Hernandez, et al. (2011) recommended lowering therapeutic targets to levels more in line with normal pregnancies. They found that mean blood glucose concentrations in 255 pregnant women of normal weight without GDM were 71 mg/dL (fasting), 109 mg/dL (1-hr), and 99 mg/dL (2-hr). Given the fact that adverse outcomes are directly linked to blood glucose concentrations, it is appealing to aim for lower levels; however, this goal must be balanced with the possibility of inducing hypoglycemia in patients with treatment.
IV. Available Treatments
IV. A. Diet and Exercise
For women with mild gestational diabetes mellitus (having blood
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