Gestational diabetes is high blood sugar that first appears during pregnancy, as placental hormones make the body resist insulin. Good control lowers the risk of a large baby, birth injury and low sugar in the newborn.
Key symptoms
- Usually no symptoms; found on routine screening
- Sometimes more thirst and more urination
- Fatigue
- A baby measuring large for dates
What you find on exam
- Weight gain and blood pressure
- Fundal height compared with gestational age
- Fetal heart rate
- Signs of preeclampsia: swelling, headache, high pressure
Tests
- Glucose challenge or glucose tolerance test at 24 to 28 weeks
- Earlier testing if high risk, such as obesity or past gestational diabetes
- Home glucose checks: fasting and after meals
- Growth ultrasounds and fetal monitoring later in pregnancy
Treatment basics
- Medical nutrition therapy and regular physical activity
- Targets: fasting under 95 mg/dL, 1 hour after meals under 140 mg/dL
- Insulin if targets are not met; metformin in selected cases
- Plan timing of delivery and check the newborn's glucose
- Glucose tolerance test 4 to 12 weeks after birth and yearly diabetes screening
Red flags
- Very high glucose or ketones in the urine
- High blood pressure, severe headache or vision changes
- Reduced fetal movements
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Sources: NCCPA PANCE Content Blueprint; AAMC Core Entrustable Professional Activities (Core EPAs); Open RN, Nursing Pharmacology 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.