What are the glycaemic targets and stepwise treatment in GDM?

Targets: fasting/pre-meal 80-90 mg/dL, post-meal <120 mg/dL, confirmed by self-monitored capillary glucose; achieved throughout the day and pregnancy.

Stepwise treatment: 1) medical nutrition therapy (diet) + exercise; 2) metformin (off-licence but safe); 3) insulin if targets not met or features of fetal hyperglycaemia (e.g. rising AC).

Clinical relevance. Achieving these targets via diet, metformin then insulin reduces macrosomia and neonatal hypoglycaemia.

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Glycaemic targets and treatment in GDM

Tight control reduces macrosomia, stillbirth and neonatal complications.

Targets

• Fasting or pre-meal: 80-90 mg/dL.
• Post-meal: under 120 mg/dL.
• Achieved throughout the day and throughout pregnancy, confirmed by regular self-monitored capillary glucose.

Stepwise treatment

1. Medical nutrition therapy (diet) and exercise - first-line; for a new GDM diagnosis with 2-hour OGTT >200 or FBS >126, MNT is still the starting point.
2. Metformin - off-licence but safe and effective.
3. Insulin - if targets are not met, or there are signs of fetal hyperglycaemia (see AC card).

Monitoring

Serial growth scans track the abdominal circumference; an AC climbing into high centiles signals fetal hyperinsulinaemia and prompts escalation.