Endocrinology
Gestational Diabetes
임신성당뇨
Glucose intolerance first recognized during pregnancy
- How common
- 7–10% of pregnancies
- Typical age
- Detected at 24–28 weeks
What is it?
Placental hormones (hPL, cortisol, progesterone) induce insulin resistance; β-cell failure to compensate causes GDM.
Commonly affected: Maternal insulin sensitivity
How it develops
- Placental hormone surgeRising hPL, cortisol, progesterone
- Insulin resistanceDecreased peripheral glucose uptake
- β-cell decompensationInadequate insulin secretion
- Fetal complicationsMacrosomia, neonatal hypoglycemia, RDS
Symptoms
- Macrosomia riskBirth weight >4 kg
- PolyhydramniosFetal polyuria
- Mostly asymptomaticDetected by screening
- Recurrent infectionsUTI, candidal vaginitis
How it is examined
- 50g GCT screening (24–28 wks)1h ≥140 mg/dL → 100g OGTT
- 100g OGTT (Carpenter-Coustan)FPG/1h/2h/3h: 95/180/155/140
- Fetal ultrasoundAssess growth and amniotic fluid
Imaging
Avoid X-ray during pregnancy.
- Contraindicated
Fetal MRI for suspected anomalies.
- Macrosomia
- Cardiac/brain anomalies
Non-surgical care
- Medical nutrition therapyCarb distribution, 1500–2200 kcal/day
- SMBG monitoringFasting + postprandial 1–2h
- Insulin (first-line)Glargine/NPH/aspart (metformin increasingly used)
- Exercise30-min postprandial walk
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Macrosomia or maternal complications
Procedures that may be discussed
- C-section (fetus ≥4.5 kg)
- Induction at 39 wks if controlled
Outlook
Most resolve postpartum; 50% develop T2DM within 10 years.