Immediate post-partum care:
- Metformin and insulin will be ceased
- If she has been on diet control only, she will not require glucose monitoring
- If she was taking Metformin or insulin, glucose is monitored for the 1st 24 hours
- Pre-meals and bedtime
- Ideally, glucose levels are between 4 and 7 mmol/L
- Breastfeeding is to be encouraged, as it is associated with:
- Reduced risk of maternal obesity and type 2 diabetes
- Reduce risk of childhood obesity and type 2 diabetes in the neonate
6 – 12-week post-partum visit:
- Oral glucose tolerance test to be performed
- Discuss the importance of maintaining healthy habits to prevent GDM or Type 2 Diabetes:
- Healthy eating and avoiding sugar, high-GI carbohydrates
- Avoidance of excessive weight gain
- Maintain active lifestyle eg. interval training, strength exercise
Long-term health care
Gestational diabetes is a strong predictor of type 2 diabetes and obesity. GDM is associated with a 50-70% risk of developing Type 2 Diabetes in the next 10 years. Her risk is higher if there are other risk factors:
- Family history of type 2 diabetes
- Obesity (BMI >30kg/m2)
- Excessive gestational weight gain
- Her ethnic background is high-risk
- Insulin requirement during pregnancy
- Age is >40 years
- She did not breastfeed
This presents an excellent opportunity to support women in maintaining healthy day-to-day habits that reduce the risk of both obesity and type 2 diabetes.
- The healthy habits that can prevent Type 2 Diabetes:
- Avoid sugar and high-GI carbohydrates
- Eat healthy fats eg. yoghurt, eggs, nuts, avocado
- Eat protein to suppress hunger eg. cheese, meat, chicken, fish, nuts
- Sleep 7-8 hours at night
- Avoid excess weight gain
- Maintain active lifestyle, especially interval training, strength exercise
- Care for dental health
- Screen for type 2 diabetes or GDM using the oral glucose tolerance test (OGTT):
- Every 2-3 years long term
- Every year if she is planning further pregnancies
- In the first trimester of all future pregnancies
Remember to screen for GDM in the next pregnancy
- Organize an OGTT in the first trimester of all future pregnancies
- She is considered high risk due to her history of GDM
- If women can maintain healthy eating habits and avoid weight gain, she can avoid diabetes in future pregnancies
