This document discusses the postpartum care of mothers who had gestational diabetes during pregnancy and their infants. It outlines that infants should be monitored for hypoglycemia after delivery and breastfeeding should be encouraged. Mothers' blood glucose levels should be checked within 48 hours to rule out diabetes, and a glucose tolerance test is recommended at 6-12 weeks postpartum since many women develop impaired glucose tolerance or type 2 diabetes. Ongoing education on weight management, family planning, screening and risk factor control is important given the high risk of future diabetes.

1. Post Partum
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2. Objectives
Discuss the immediate care of the infant
Discuss the importance of breast feeding
Discuss follow up screening of the mother
Discuss risk of IGT or diabetes in future
Discuss follow up education for mother
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3. After delivery – the infant
Watch for signs of hypoglycemia
Check blood glucose – heel prick
 Within 1st hour after delivery
 After each of 1st 4 feeds
Less than 2.6 mmol/L or 44 mg/dl defined as
hypoglycemia
Treatment of hypoglycemia
 Topfeeding/glucose in water/ IV dextrose
Seshiah, Balaji, 2006
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4. After delivery – the infant
Usual care
 Vital signs
 Apgar scores
 Pre-warmed incubator
 Start breast feeding within 30 minutes for better latching
 Watch for jaundice – check bilirubin
 If macrosomic, check calcium and magnesium on day 2
Seshiah, Balaji, 2006
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5. After delivery - mother
Exogenous insulin not required after placenta is
delivered
Blood glucose usually returns to normal
Check fasting within 48 hours to rule out type 1 or
type 2 diabetes
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6. Breast feeding
Encourage for all
Protects infant from over or undernutrition
during early childhood
May lower risk of
 Obesity
 Hypertension
 Cardiovascular disease
 Diabetes
Gunderson, 2007
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7. Post partum period
Encourage mother to achieve healthy weight.
• Healthy eating
• Adequate intake to sustain breast feeding
• Regular activity
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8. Future pregnancies
Should be planned
Education regarding birth control is needed
Encourage achieving healthy weight prior to
conceiving again
Check blood glucose levels well ahead of
conception allowing time to normalize if necessary
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9. Contraception
Any method of contraception can be safely used in
a woman with history of GDM
• Intrauterine devices are commonly used
Progesterone-only oral contraceptives are the best
choice within the first 6 weeks post partum
• They have the lowest risk of thrombosis
• Preferred during breastfeeding
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10. Glucose tolerance testing
Should be done 6-12 weeks post partum
Fasting glucose testing is not sufficient to
identify all who have IGT or type 2 diabetes
 Only 34% of women with IGT or type 2 had elevated
fasting glucose levels
 44% of those with type 2 had fasting less than 5.5
mmol/L (100 mg/dL)
OGTT should be done
Metzger, Buchanan, Coustan et al. 2007
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11. CVD risk
Women with GDM may have many of
characteristics of metabolic syndrome
Hypertension, dyslipidemia, obesity, IGT should all
be evaluated and treated
Metzger, Buchanan, Coustan et al. 2007
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12. Postpartum education is key
OGTT at 6-12 weeks
Managing risk factors
 Obesity
 Hypertension
 Dyslipidemia
Birth control
Preconception screening
Annual screening for diabetes – 35-60% risk of
type 2 within 10 years
Metzger, Buchanan, Coustan et al. 2007
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13. References
Gunderson EP. Breastfeeding after gestational diabetes pregnancy. Diabetes Care. 2007;30(suppl 2):S161-168.
Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Hadden DR, Hod M. Summary and recommendations of
the fifth international workshop-conference on gestational diabetes mellitus, Diabetes Care. 2007; 30(suppl
2):S251-260.
Seshiah V, Balaji V, et al. Gestational Diabetes Mellitus – Guidelines. J Assoc Physic of India 2006;54:622-28.
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