Skip to main content

Table 3 Recommendations summary

From: Current guidelines on the management of gestational diabetes mellitus: a content analysis and appraisal

Health questions Description Guideline Recommendations (example)
Diagnosis of GDM
 Risk factors Factors that make pregnant women more likely to get GDM and should be recognized 2 evidence-based guidelines (NICE, CDA)
2 expert consensus (HKCOG, CMA)
Assess risk of gestational diabetes using risk factors in a healthy population. At the booking appointment, determine the following risk factors for gestational diabetes: BMI above 30 kg/m2; previous macrosomia baby weighing 4.5 kg or above; previous gestational diabetes; family history of diabetes (first-degree relative with diabetes); minority ethnic family origin with a high prevalence of diabetes.
 Screening Screening method to identify women who have GDM 9 evidence-based guidelines (NICE, NZGG, SIGN, ADA, FIGO, NGC, CA, API, IDF)
2 expert consensus (HKCOG, CMA)
Use the 2-h 75 g oral glucose tolerance test (OGTT) to test for gestational diabetes in women with risk factors.
Offer women with any of the other risk factors for gestational diabetes a 75 g 2-h OGTT at 24–28 weeks.
 Diagnostic criteria Diagnostic criteria for GDM 7 evidence-based guidelines (SIGN, ADA, FIGO, NGC, A.N.D., DDG Queensland)
2 expert consensus (HKCOG, CMA)
GDM should be diagnosed at any time in pregnancy if one or more of the following criteria are met following a 75 g glucose load: fasting PG 5.1–6.9 mmol/l; 1-h PG ≥ 10.0 mmol/l; 2-h PG 8.5–11.0 mmol/l
Prenatal Care
 Health education Inform women with GDM relevant information 7 evidence-based guidelines (NICE, NZGG, SIGN, ADA, FIGO, IDF, A.N.D.)
1 expert consensus (CMA)
Explain that: in some women, gestational diabetes will respond to changes in diet and exercise; the majority of women will need oral blood glucose-lowering agents or insulin therapy if changes in diet and exercise do not control gestational diabetes effectively; if gestational diabetes is not detected and controlled, there is a small increased risk of serious adverse birth complications such as shoulder dystocia; a diagnosis of gestational diabetes will lead to increased monitoring, and may lead to increased interventions, during both pregnancy and labor.
 Medical nutrition therapy Medical nutrition therapy (MNT) recommendations for management of GDM that assist in achieving and maintaining glycemia, and reducing the risk of adverse maternal and neonatal outcomes 11 evidence-based guidelines (NICE, NZGG, SIGN, ADA, FIGO, NGC, CDA, API, IDF, Queensland, A.N.D.)
2 expert consensus (HKCOG, CMA)
In women with GDM, the registered dietitian nutritionist (RDN) should provide adequate amounts of macronutrients to support pregnancy, based on nutrition assessment, with guidance from the Dietary Reference Intakes (DRI).
 Physical activity Physical activity recommendations for management of GDM. 6 evidence-based guidelines (NICE, ADA, FIGO, NGC, IDF, DDG)
2 expert consensus (HKCOG, CMA)
Advice regular exercise (such as walking for 30 min after a meal) to improve glycemic control.
 Pharmacological therapy Pharmacological therapy for management of GDM, including insulin and oral hypoglycemic agents 5 evidence-based guidelines (ADA, CDA, API, IDF, DDG)
1 expert consensus (CMA)
For women who are non-adherent to or who refuse insulin, glyburide or metformin may be used as alternative agents for glycemic control.
 Blood glucose monitoring Effect blood glucose monitoring method in predicting adverse outcomes in women with GDM 9 evidence-based guidelines (NICE, SIGN, ADA, FIGO, NGC, CDA, API, IDF, Queensland,)
2 expert consensus (HKCOG, CMA)
Self-monitoring of blood glucose is recommended for all pregnant women with diabetes, 3–4 times a day:
• Fasting: once daily, following at least 8 h of overnight fasting
• Postprandial: 2–3 times daily, 1 or 2 h after the onset of meals, rotating meals on different days of the week
 Target blood glucose values Target ranges for blood glucose in women with GDM 7 evidence-based guidelines (NICE, NZGG, ADA, FIGO, NGC, CDA, API)
2 expert consensus (HKCOG, CMA)
Targets for glucose control during pregnancy:
• Fasting glucose < 5.3 mmol/L
• 1-h postprandial < 7.8 mmol/L
• 2-h postprandial < 6.7 mmol/L
 Ketone monitoring Ketone monitoring and target ranges in pregnancy in women with GDM 1 evidence-based guidelines (NICE)
1 expert consensus (CMA)
Test urgently for ketoaemia if a pregnant woman with any form of diabetes presents with hyperglyaemia or is unwell, to exclude diabetic ketoacidosis.
 HbA1c monitoring HbA1c monitoring and target ranges in pregnancy in women with GDM 2 evidence-based guidelines (NICE, IDF)
1 expert consensus (CMA)
Use HbA1c as an ancillary aid to self-monitoring. Aim for an HbA1c < 6.0%, or lower if safe and acceptable.
 Continuous glucose monitoring continuous glucose monitoring recommendations during pregnancy 3 evidence-based guidelines (NICE, NGC, API)
1 expert consensus (CMA)
Do not offer continuous glucose monitoring routinely to pregnant women with diabetes.
 Fetal monitoring Screening for congenital malformations and monitoring fetal growth and wellbeing 4 evidence-based guidelines (NICE, NZGG, SIGN, FIGO)
1 expert consensus (CMA)
Offer women with GDM an ultrasound scan at the time of diagnosis and at 36–37 weeks. Further ultrasound scans should be based on clinical indications. Treatment decisions should not be based solely on fetal ultrasound.
Intrapartum Care
 Timing and mode of birth Optimal timing and mode of birth in women with GDM 4 evidence-based guidelines (NICE, NZGG, SIGN, FIGO)
1 expert consensus (CMA)
Discuss the timing and mode of birth with pregnant women with diabetes during antenatal appointments, especially during the third trimester.
 Glycemic control Maintaining maternal blood glucose in target range during labor and birth to reduce the incidence of neonatal hypoglycemia and reduce fetal distress. 6 evidence-based guidelines (NICE, SIGN, FIGO, NGC, CDA, API)
1 expert consensus (CMA)
Women should be closely monitored during labor and delivery, and maternal blood glucose levels should be kept between 4.0 and 7.0 mmol/L in order to minimize the risk of neonatal hypoglycemia.
Neonatal Care
 Neonatal hypoglycemia Prevention, assessment and treatment of neonatal hypoglycemia 3 evidence-based guidelines (NICE, NZGG, SIGN)
1 expert consensus (CMA)
Measure the infant’s plasma glucose at 1–2 h of age, 4 h, and then 4-hourly, preferably before feeds, until there have been three consecutive readings > 2.6 mmol/L.
 Initial assessment Neonatal assessment and criteria for admission to intensive or special care 2 evidence-based guidelines (NICE, NGC)
1 expert consensus (CMA)
Carry out blood glucose testing routinely in babies of women with diabetes at 2–4 h after birth. Carry out blood tests for polycythemia, hyperbilirubinemia, hypocalcemia and hypomagnesemia for babies with clinical signs.
Postpartum Care
 Blood glucose control Including taking insulin, oral hypoglycemic agents to control blood glucose and using other medicines, as well as breastfeeding after birth 6 evidence-based guidelines (NICE, NZGG, NGC, CDA, API, IDF)
2 expert consensus (HKCOG, CMA)
Women should be encouraged on breastfeeding. They can resume or continue to take metformin and glibenclamide immediately after birth as required, but should avoid other forms of oral hypoglycemic agents while breastfeeding.
 Information and follow-up Education interventions after delivery 8 evidence-based guidelines (NICE, NZGG, SIGN, ADA, FIGO, NGC, IDF, Queensland)
2 expert consensus (HKCOG, CMA)
Women diagnosed with hyperglycemia in pregnancy should be informed about the increased risk of future DM and hyperglycemia in future pregnancy and should be offered lifestyle advice including weight control, diet and exercise.
 Postnatal blood glucose testing Accuracy and timing of postnatal blood glucose testing in women who had GDM 8 evidence-based guidelines (NICE, NZGG, SIGN, ADA, NGC, CDA, IDF, DDG)
2 expert consensus (HKCOG, CMA)
Offer a postnatal test at 6–12 weeks to exclude DM, either OGTT or HbA1c (with or without fasting glucose).