Gestational diabetes after delivery. Short-term management and long-term risks.

A fter the intensified treatment often required for treating gestational diabetes mellitus (GDM), clinicians may be tempted to relax after delivery of the baby. If it is assumed that no further management is needed, an excellent opportunity to improve the future health status of these high-risk women may be lost. There are special concerns for the early postpartum care of women with GDM. Encouragement and facilitation of exclusive breastfeeding is very important because of the profound short-term as well as long-term health benefits to the infant and the reduced risks for subsequent obesity and glucose intolerance demonstrated in many breastfeeding women. A method of contraception should be chosen that does not increase the risk of glucose intolerance in the mother. Some women with GDM will have persisting hyperglycemia in the days after delivery that will justify medical management for diabetes and perhaps for hypertension, microalbuminuria, and dyslipidemia. Treatment should be maintained according to the guidelines of the American Diabetes Association and other relevant organizations and adjusted for the needs of lactation. Treatment should be continued in adequate fashion to minimize risks to the early conceptus if there is a subsequent planned or unplanned pregnancy. Most women with GDM will not have severe hyperglycemia after delivery. This group should be followed for at least 6 –12 weeks to determine their glucose status. Many studies over 3 decades on all continents of the globe demonstrate the high risk of subsequent diabetes in this female population. The degree of this risk is best assessed by glucose tolerance testing. Randomized controlled trials have proven that several interventions (diet and planned exercise 30 – 60 min daily at least 5 days per week and antidiabetic medications) can significantly delay or prevent the appearance of type 2 diabetes in the women with impaired glucose tolerance (IGT). The high-risk women can also be assessed for cardiovascular risk factors, with appropriate management and follow-up to reduce the risk of coronary heart disease, cardiomyopathy, and stroke. These women should be educated to seek specific preconception consultation before the next pregnancy to avoid the teratogenic effect of unrecognized diabetes.