Recommendations and Conclusions

Document Overview

Design and created by Guideline Central in participation with the American College of Obstetricians and Gynecologists.

Gestational Diabetes Mellitus

American College of Obstetricians and Gynecologists

Publication Date: Feb 1, 2018

Page Last Updated: May 5, 2026

The following recommendations and conclusions are based primarily on consensus and expert opinion.

In the absence of clear evidence that supports one cutoff value over another (ie, 130 mg/dL, 135 mg/ dL, or 140 mg/dL) for the 1-hour glucose screening test, obstetricians and obstetric care providers may select one of these as a single consistent cutoff for their practice, using factors such as community prevalence rates of GDM when making their decision.
In the absence of clear comparative trials, one set of diagnostic criteria for the 3-hour OGTT cannot be clearly recommended over the other. Given the benefits of standardization, practitioners and institutions should select a single set of diagnostic criteria, either plasma or serum glucose levels designated by the Carpenter and Coustan criteria or the plasma levels established by the National Diabetes Data Group, for consistent use within their patient populations.
Once a woman with GDM begins nutrition therapy (dietary counseling), surveillance of blood glucose levels is required to confirm that glycemic control has been established.
In practice, three meals and two to three snacks are recommended to distribute carbohydrate intake and to reduce postprandial glucose fluctuations.
Women with GDM should aim for 30 minutes of moderate-intensity aerobic exercise at least 5 days a week or a minimum of 150 minutes per week.
The timing of delivery in women with GDM that is controlled with only diet and exercise (A1GDM) should not be before 39 weeks of gestation, unless otherwise indicated. In such women, expectant management up to 40 6/7 weeks of gestation in the setting of indicated antepartum testing is generally appropriate.
For women with GDM that is well controlled by medications (A2GDM), delivery is recommended at 39 0/7 to 39 6/7 weeks of gestation.
Screening at 4–12 weeks postpartum is recommend- ed for all women who had GDM to identify women with diabetes, impaired fasting glucose levels, or impaired glucose tolerance. Women with impaired fasting glucose, IGT, or diabetes should be referred for preventive or medical therapy. The ADA and ACOG recommend repeat testing every 1–3 years for women who had a pregnancy affected by GDM and normal postpartum screening test results.
Women with GDM should be counseled regarding the risks and benefits of a scheduled cesarean delivery when the estimated fetal weight is 4,500 g or more.

( C )

Recommendation Grading

Quality of Evidence
Level	Description
A	Multiple randomized controlled clinical trials or meta-analyses
B	Single randomized trial or nonrandomized studies
C	Consensus opinion of experts, case studies or standard-of-care

Document Overview

Document Title: Gestational Diabetes Mellitus

Authoring Society: American College of Obstetricians and Gynecologists

Document Publication Date: Feb 1, 2018

Page Last Reviewed/Updated: May 5, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: No

Full Text Guideline: www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/02/gestational-diabetes-mellitus

Document Scope, Criteria, and Use Cases

Scope: Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D016640 - Diabetes, Gestational

Keywords: GDM, gestational diabetes, gestational diabetes mellitus

Inclusion Criteria: Female, Adolescent, Adult

Health Care Settings: Ambulatory

Intended Users: Diabetes Educator, Dietician/Nutritionist, Nurse, Nurse Midwife, Nurse Practitioner, Physician, Physician Assistant

Gestational Diabetes Mellitus

Recommendations and Conclusions

The following recommendations and conclusions are based on good and consistent scientific evidence.

The following recommendations and conclusions are based on limited or inconsistent scientific evidence.

The following recommendations and conclusions are based primarily on consensus and expert opinion.

Recommendation Grading

Document Overview

Document Scope, Criteria, and Use Cases