Date of Award

5-2019

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Julie Solberg

Keywords

Gestational diabetes mellitus, macrosomia, neonatal hyperglycemia, glyburide, metformin, insulin, continuous subcutaneous insulin infusion (CSII)

Abstract

Gestational diabetes mellitus (GDM) is a known potential complication that can occur during pregnancy. Unmanaged GDM can result in maternal hyperglycemia, which can cause increased neonatal complications, two of which are macrosomia and neonatal hypoglycemia. To prevent maternal hyperglycemia, treatment of GDM typically begins with dietary changes, home glucose monitoring, increased exercise patterns and other lifestyle modifications. However, if maternal hyperglycemia persists after two weeks of maternal lifestyle modifications, there are not current best practice guidelines established for the treatment of GDM. Historically, subcutaneous multiple daily dosed insulin (MDI) has been the gold standard for treatment after lifestyle modification. However, in more recent years oral antihyperglycemic medications, glyburide and metformin, have seen increased use for the treatment of GDM. Additionally, with advancing technology and the development of continuous subcutaneous insulin infusion (CSII), there is discussion regarding which insulin delivery method will achieve more consistent rates of euglycemia to help reduce rates of neonatal hypoglycemia and macrosomia. This scholarly literature review will provide a general overview of GDM, compare treatment modalities (subcutaneous multiple daily dosages of insulin, continuous subcutaneous insulin infusion, metformin and glyburide) of GDM in terms of rates of neonatal hypoglycemia and macrosomia, and compare the safety of differing treatment modalities.

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