Comprehensive care for pregnant women with gestational diabetes - Nº 88 - august 2024

Q: What is gestational diabetes and how does it relate to type 2 diabetes?

Gestational diabetes refers to glucose intolerance that begins or is first recognized during pregnancy. It is a precursor to type 2 diabetes, sharing key mechanisms such as insulin resistance and pancreatic β-cell dysfunction.

Q: How is gestational diabetes screened and confirmed?

Screening is recommended between weeks 24 and 28 using the O’Sullivan test: blood glucose is measured 1 hour after an oral load of 50 g glucose. If the 1-hour value is >140 mg/dL, confirmation requires an oral glucose tolerance test with glucose dosing and fasting requirements.

Oct 4, 2026

Uploaded by Aran

Gestational diabetes (GD) is glucose intolerance first recognized during pregnancy and is linked to insulin resistance and pancreatic β-cell dysfunction. The material outlines screening for all eligible pregnant women between weeks 24–28 using the O’Sullivan test, followed by an oral glucose tolerance test for confirmation. It details GD categories (A1, A2) prevalence in Spain, diagnostic criteria, and glycemic targets. Comprehensive prenatal care covers glycemic control, pharmacologic therapy when needed, nutrition distribution, physical activity, and psychological support addressing depression and anxiety.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

1. INTRODUCTION

2. DIAGNOSIS

3. COMPREHENSIVE PRENATAL CARE

Diabetes GESTATIONAL DIABETES / Nº 88 august 2024 Silvia Ponce Delgado. EPA in EGC and EPA in Diabetes. Hospital Universitario de Jerez (SAS). (Jerez, Spain) Ana Domínguez Navarro. EPA in Diabetes and Nursing Researcher. Faculty of Nursing and Physiotherapy, Universidad de Cádiz. (Cadiz, Spain) . Comprehensive care for pregnant women with gestational diabetes 1. INTRODUCTION Gestational diabetes (GD) is any degree of glucose intolerance that begins or is first recognized during pregnancy¹. GD is a precursor to type 2 diabetes mellitus, and both share a common pathophysiology: insulin resistance and dysfunction of pancreatic β cells². » Nº 88 august 2024 / GESTATIONAL DIABETES Diabetes » GD can be categorized into¹: Gestational Diabetes A1: controlled without medication and responds to nutritional treatment. It can also be referred to as diet-controlled gestational diabetes. Gestational Diabetes A2: controlled with medication to achieve adequate glycemic control. In Spain, the prevalence of GD is 32. 8%³ and is increasing due to advanced maternal age at the time of gestation and rising obesity in the population². 2. DIAGNOSIS Screening for GD is recommended for all pregnant women (without a prior diagnosis of type 1 or type 2 diabetes mellitus) between weeks 24 and 28 of pregnancy¹ (Table 1) . Screening is conducted using the O’Sullivan test, which involves measuring blood glucose 1 hour after administering 50 grams of glucose orally. If the blood glucose at one hour is > 140 mg/dL, the O’Sullivan test is considered positive. In the case of a positive screening, diagnostic confirmation with an oral glucose tolerance test is necessary. The oral glucose tolerance test consists of administering 75-100 grams of glucose orally and determining blood glucose levels before and after glucose administration. It is essential that thereis fasting for 8-14 hours and that in the 3 days prior, a diet with a minimum intake of 150 g/day of carbohydrates and physical activity is followed. During the test, the woman should remain at rest and seated² . However, the American Diabetes Asso- ciation (ADA) recommends distinguishing between women with pre-existing diabetes diagnosed for the first time during pregnancy and those who exhibit a transient insulin resistance related to pregnancy⁵,². 3. COMPREHENSIVE PRENATAL CARE The recommendations for comprehensive prenatal care for a woman with GD areas follows: Glycemic Control: Regular monitoring of blood glucose levels during pregnancy is necessary to ensure they remain within safe limits for gestation. This is especially crucial when starting insulin treatment. It is recommended to perform four capillary blood glucose tests per day: fasting, preprandial, and postprandial at lunch or dinner (on alternate days) or to implement continuous glucose » TABLE 1. Diagnostic criteria for diabetes (4) . | WHEN? | WHO? | HOW? | WHERE? | | --- | --- | --- | --- | | 1st trimester | High-risk pregnant women:
• Age > 35 years.
• Obesity (BMI > 30) .
• Personal history of GD
• Poor obstetric history.
• Family history of DM in first-degree relatives.
• Ethnic minorities (Southeast Asians, Latin Americans, etc.) | O’Sullivan test. Oral glucose load of 50g. | At the health center, as priority patients. | | 2nd trimester
(between 24-28 weeks) | All pregnant women not previously diagnosed. | | | | 3rd trimester | Pregnant women with complications associated with GD not previously diagnosed. | Oral glucose load of 50g. | At the hospital. | TABLE 2. Glycemic targets for women with gestational diabetes. | PARAMETER | TARGET VALUES | | --- | --- | | Fasting glucose | 70-95 mg/dL | | Postprandial glucose (1 hour) | 110-140 mg/dL | | Postprandial glucose (2 hours) | 100-120 mg/dL | | Continuous glucose monitoring | Time in range (63-140 mg/dL)> 70% Time < 63 mg/dL< 4%
Time > 140 mg/dL< 25% | | HbA1c within the 1st trimester | < 6.5%

FAQs

What is gestational diabetes and how does it relate to type 2 diabetes?

Gestational diabetes refers to glucose intolerance that begins or is first recognized during pregnancy. It is a precursor to type 2 diabetes, sharing key mechanisms such as insulin resistance and pancreatic β-cell dysfunction.

How is gestational diabetes screened and confirmed?

Screening is recommended between weeks 24 and 28 using the O’Sullivan test: blood glucose is measured 1 hour after an oral load of 50 g glucose. If the 1-hour value is >140 mg/dL, confirmation requires an oral glucose tolerance test with glucose dosing and fasting requirements.

What does comprehensive prenatal care include for women with gestational diabetes?

Comprehensive care includes regular glycemic monitoring, lifestyle measures, and pharmacological treatment when needed, with insulin as the preferred option. It also covers nutritional therapy, moderate physical activity, and psychological support for depression, anxiety, and post-traumatic stress risk.

Oct 4, 2026

Uploaded by Aran