Monitoring
Postpartum Management
In addition to routine obstetric care, immediate postpartum management should prioritize glycemic control. Evaluate and adjust Insulin requirements after delivery due to the dramatic decrease in insulin resistance immediately postpartum. All women, including those with gestational diabetes mellitus, are encouraged to exclusively breastfeed. It may decrease offspring obesity and prevent the development of type 2 DM. Except for Metformin and Glibenclamide, other oral hypoglycemic agents should be avoided while breastfeeding. Early feeding of the baby is advised to reduce the risk of neonatal hypoglycemia.
Overweight or obese women with a history of gestational diabetes mellitus who have prediabetes should be offered intensive lifestyle intervention or Metformin to prevent diabetes. Postpartum support for self-care and psychosocial assessment is also recommended to detect the onset of anxiety, depression, stress, and eating disorders. Establish and implement a contraceptive plan for all individuals with diabetes of childbearing potential.
Postpartum Diabetes Mellitus (DM) Screening
All women who will be identified to have overt DM during pregnancy or have gestational diabetes mellitus should have postpartum glucose testing. Women with gestational diabetes mellitus should be screened for persistent DM 4-12 weeks postpartum as the risk of developing maternal type 2 diabetes is increased after pregnancy and because GDM may be an undiagnosed pre-existing type 1 or 2 diabetes. Probability of progression to DM is high with the following postnatal test results: Impaired glucose tolerance with 75-g OGTT, A1c of 5.7-6.4%, and FPG of 5.7-6.9 mmol/L. This uses the 75-g OGTT, fasting plasma glucose test, and non-pregnancy diagnostic criteria. OGTT is more sensitive to detecting glucose intolerance, prediabetes, and diabetes. A1c is not advised for diagnosis of postpartum-persistent diabetes; it may be offered at 1 year postpartum in women with gestational diabetes mellitus who have negative postnatal tests for diabetes. Lifelong screening for development of type 2 DM or prediabetes at least every 1-3 years is recommended for all women with a history of gestational diabetes mellitus, with screening frequency depending on other risk factors.