The following guidelines should be considered when managing inmates with GDM:
• Close surveillance of the mother and fetus must be maintained throughout the pregnancy. Self-monitoring of blood glucose should be done on a frequent (daily) basis. Use of post-prandial monitoring is preferred. Monitoring of urinary glucose is not an adequate measure.
• Screening for hypertension should include measurement of blood pressure and urine protein.
• Clinical estimation of fetal size and asymmetric growth via serial ultrasounds, especially early in the third trimester, may identify large infants who would benefit from maternal insulin therapy.
• All inmates with GDM should receive dietary counseling and be provided with adequate calories and nutrients during pregnancy.
• Insulin therapy should be considered if dietary management does not result in:
(1) the fasting whole blood glucose <95 mg/dL, or
(2) the fasting plasma glucose <105 mg/dL, or
(3) the two-hour postprandial whole blood glucose <120 mg/dL, or
(4) the-two hour postprandial plasma glucose <130 mg/dL.
• Oral hypoglycemic agents should be considered in lieu of insulin on a case-by-case basis, but only after careful consultation with an obstetrician; their efficacy and safety are still being investigated.
• Breast feeding should be encouraged in women with gestational diabetes mellitus.
• Whenever possible, care should be coordinated with an obstetrician experienced in the treatment of women with gestational diabetes.