Retrospective Review of Maternal and Fetal Outcomes in Patients With Gestational Diabetes Mellitus in an Indigent Prenatal Clinic

Gestational diabetes mellitus (GDM) is diabetes that is diagnosed during the second or third trimester of pregnancy and is not clearly overt diabetes (1). Diagnosis is defined by severity of carbohydrate intolerance. The upper end of the GDM diagnostic glucose range is the same as would be indicative of diabetes outside of pregnancy, whereas the lower end of the GDM range is only slightly above normal and asymptomatic but still associated with increased risk of fetal morbidity (1,2). Diabetes during pregnancy is diagnosed by either a one-step approach involving a 75-g oral glucose tolerance test (OGTT) or a two-step approach starting with a 50-g (nonfasting) screen followed by a 100-g OGTT for those who initially screen positive (1). Glycemic goals for patients with a GDM diagnosis are as follows: preprandial ≤95 mg/dL and either 1-hour postprandial ≤140 mg/dL or 2-hour postprandial ≤120 mg/dL. Hyperglycemia throughout pregnancy carries increased risk for adverse fetal and maternal outcomes (3–8). Treatment of diabetes during pregnancy is aimed at decreasing the risk of perinatal outcomes such as macrosomia, birth trauma, neonatal metabolic abnormalities, and cesarean section (4,9–12). Lifestyle modification is first-line treatment and includes medical nutrition therapy (MNT), exercise, and glucose monitoring (13). Pharmacological therapy generally consists of insulin, glyburide, or metformin, and agents may be used adjunctly to MNT depending on presence and severity of hyperglycemia (13). Insulin is the preferred pharmacological treatment for management of diabetes in pregnancy if lifestyle modification is insufficient in achieving euglycemia (13). The setting of this review is the diabetes clinic located within the Hall County Health Department (HCHD) prenatal clinic in Gainesville, Ga. The population of Gainesville is ∼187,000 and includes a large percentage of Latino immigrants (14). The proportion of Latinos in the diabetes clinic has grown …