Patient handout

Gestational diabetes (GDM)

PRODUCTION

1. Your condition

This handout is for gestational diabetes (gdm). Your care team identified this based on: positive 50g gct or 75g/100g ogtt (24-28 wk) (acog 190 2018; ada 2026 §15).

Other reasons your team may use this plan: routine 24-28 wk universal screening (acog 190 2018; ada 2026 §15); early-pregnancy a1c ≥6.5% / fpg ≥126 (overt dm in pregnancy) (ada 2026 §15).

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — On track — targets met

If you have:

Fasting BG 70–95 mg/dL (ADA 2026 §15)
1h postprandial <140 mg/dL (ADA 2026 §15)
2h postprandial <120 mg/dL (ADA 2026 §15)
No symptoms (ACOG 190 2018)
Normal fetal movements (ACOG 190 2018)

Do this:

Continue MNT (carb distribution + portion control) (ACOG 190 2018)
Continue insulin/metformin if prescribed (ACOG 190 2018)
Daily kick counts after 28 wk (ACOG 190 2018)
Weekly OB visits in third trimester (ACOG 190 2018)
Bring SMBG log to every visit (ADA 2026 §15)

YELLOW — Caution — out-of-target glucose

If you have:

Fasting BG >95 mg/dL on ≥2 days/week (ADA 2026 §15)
1h postprandial >140 mg/dL on ≥2 days/week (ADA 2026 §15)
2h postprandial >120 mg/dL on ≥2 days/week (ADA 2026 §15)
New diet difficulties (ACOG 190 2018)
Mild weight loss or excess gain (ACOG 190 2018; ADA 2026 §15)

Do this:

Review carb distribution + portion sizes (ACOG 190 2018)
Increase activity (10–15 min walk after meals) (ADA 2026 §15)
Contact OB/diabetes team within 1 week if persistently out of target (ACOG 190 2018)
Bring SMBG log to next visit; insulin start may be needed (ACOG 190 2018)
Continue daily kick counts (ACOG 190 2018)

Call your provider if:

Persistent fasting >95 or postprandial out of target ≥7 days (ADA 2026 §15)
Difficulty following MNT (ACOG 190 2018)
New symptoms (excessive thirst/urination) (ADA 2026 §15)

RED — Emergency — DKA, severe hypo, decreased fetal movement, severe HTN

If you have:

BG >300 mg/dL with vomiting / abdominal pain / Kussmaul (rare in GDM but possible) (ADA 2026 §15)
BG <54 OR severe hypo requiring assistance (ADA 2026 §15)
Decreased fetal movement (<10 movements/2h) (ACOG 190 2018)
BP ≥160/110 OR severe headache, visual changes, RUQ pain (preeclampsia) (ACOG 190 2018)
Vaginal bleeding / contractions / leaking fluid (ACOG 190 2018)

Do this:

Severe hypo: take 15 g fast carb (juice, glucose tabs); recheck 15 min; have caregiver give glucagon if unable to swallow + call 911 (ADA 2026 §15)
High BG with symptoms: call OB/911 + go to L&D (ACOG 190 2018)
Decreased fetal movement: L&D now (ACOG 190 2018)
Severe BP / headache / vision changes: L&D now (preeclampsia) (ACOG 190 2018)
Bleeding / contractions: L&D now (ACOG 190 2018)

Call your provider if:

Any red zone trigger — go to L&D, do not wait (ACOG 190 2018)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

New BP ≥140/90 OR proteinuria OR severe-features symptoms (ACOG 190 2018)
A1c ≥6.5% OR FPG ≥126 in early pregnancy (ADA 2026 §15)
EFW ≥4500 g in GDM (ACOG 190 2018)

5. Follow-up

Postpartum 75g OGTT at 4-12 wk; lifelong T2DM screening q3y; lactation support (reduces future DM); pre-pregnancy planning for next pregnancy; metformin for prevention if prediabetes (ADA 2026 §15; ACOG 190 2018)

6. Sources

Guideline: ACOG Practice Bulletin 190 (GDM, 2018, reaffirmed) + ADA Standards of Care 2026 Ch 15 (Management of Diabetes in Pregnancy) + IADPSG one-step 75g OGTT consensus + USPSTF 2021 (aspirin for PE prevention) + Carpenter-Coustan two-step thresholds. Canonical trials (PMIDs live-verified in pmids[]): ACHOIS (Crowther NEJM 2005), Landon MFMU NEJM 2009, HAPO Metzger NEJM 2008, MIG Rowan NEJM 2008.