Managing Gestational Diabetes During and After Pregnancy

November is National Diabetes Month. This year, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, is celebrating the month by promoting health after gestational diabetes.

Gestational diabetes is a type of diabetes that develops during pregnancy. Up to one in every 10 pregnancies in the United States is affected by gestational diabetes, and it can pose significant health complications for both the mother and baby.¹

The  International Federation of Gynecology and Obstetrics (FIGO) has even recommended that hyperglycemia/ gestational diabetes be considered a global health priority. Hyperglycemia and gestational diabetes are the leading cause of maternal mortality, results in a higher incidence of maternal morbidity and leads to long-term consequences for both the mother and the child.²

In most cases, gestational diabetes goes away after the baby is born, but both the mother and baby are at a higher risk for developing type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC), half of all women who had gestational diabetes go on to develop type 2 diabetes.¹

While the NIDDK is rightly promoting the prevention of developing type 2 after gestational diabetes, this month attention should also be given to managing a mother’s glucose during labor.

Protocols for maintaining normoglycemia during labor and delivery are necessary to achieve optimal results, not only for the mother but also for the newborn. Maternal hyperglycemia can lead to the baby having hypoglycemia immediately following the delivery. Neonatal hypoglycemia is the leading cause of NICU admissions, and it occurs in up to half of infants born to mothers with type 1 of type 2 diabetes and between 5 to 20% of infants born to mothers with gestational diabetes.³

Using an electronic glucose management system (eGMS) can help hospitals  achieve and maintain target glucose levels. During a session at the 2018 EndoTool® User Group Meeting, Maresa Glass, PharmD, BCPS, BCCCP, a Critical Care Pharmacotherapy Specialist at Tampa General Hospital, presented on the glycemic management in obstetrics and their use of EndoTool.

Tampa General Hospital implemented EndoTool IV in 2007 and started to use the application within Obstetrics in 2015. In a retrospective analysis comparing results before and after the implementation, they saw that the average time to goal decreased from more than 12 hours to less than 4 hours, the percentage of blood glucoses within the goal doubled and hypoglycemia reduced when using EndoTool IV.³

As we celebrate National Diabetes Month, we should raise awareness for health after gestational diabetes, but also best practices for managing blood glucose during labor and delivery in order to achieve optimal health outcomes.

References:

1. Diabetes Home. (2017, July 25). Retrieved from https://www.cdc.gov/diabetes/basics/gestational.html
2. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on Gestational Diabetes Mellitus: A Pragmatic Guide for Diagnosis, Management, and Care. Int J Gynecol Obstet 2015;131(Suppl 3):S173-212.
3. Glass, M., PharmD, BCPS, BCCCP. (2018, October 18). A Case Study: The Use of EndoTool in Obstetrics. Speech presented at EndoTool User Group Meeting, Charlotte, NC.