Postpartum management for gestational diabetes mellitus: Policy and practice implications

Purpose: The pathogenesis of gestational diabetes mellitus (GDM) and insulin resistance, risk factors, links to diabetes following the pregnancy, and clinical practice recommendations for this population are reviewed. Economic implications and future research needs are included. Data sources: Review of original studies and metaanalyses from Medline, PubMed, CINAHL, Cochrane Library Online, and other scientific and public health literature; personal clinical experience with the population and dissertation research with women who experience GDM. Conclusions: GDM is a common condition experienced during pregnancy that is associated with long-term maternal risks for the development of type 2 diabetes following the index pregnancy. For the woman with GDM, the trajectory of diabetes development can often be prevented or postponed with comprehensive education and lifestyle changes, but there is evidence to suggest that preventive efforts directed at this population can be improved. Because the prevalence of type 2 diabetes and glucose intolerance as well as the costs of treatment of these disorders are escalating in the United States, attention should be focused on this vulnerable population. Implications: Nurse practitioners need to be cognizant of the risks for diabetes and should follow clinical practice recommendations for routine screening and implementing preventive strategies for women who experience GDM. Office reminder systems such as standardized documentation flow sheets and electronic medical records may assist with provider adherence to practice recommendations. Strict postpartum screening and management may help reduce risks for developing diabetes in this vulnerable population.