Measurement of fasting ketonuria and capillary blood glucose after main meals in women with gestational diabetes mellitus: How well is the metabolic picture captured?

Abstract

A substantial proportion of metabolic abnormalities in GDM women are not detected with a monitoring program that measures only fasting ketonuria and postprandial CBG after main meals.

Inadequate Weight Gain According to the Institute of Medicine 2009 Guidelines in Women with Gestational Diabetes: Frequency, Clinical Predictors, and the Association with Pregnancy Outcomes

“…It is usually recommended to monitor ketones in women with GDM displaying overt hyperglycemia and/or weight loss during follow-up even when this has not been formally tested to improve fetal outcomes [ 53 ]. In fact, it has been our practice for decades [ 54 ] to recommend urinary ketone monitoring in women with GDM and not only before breakfast [ 55 ] in order to identify its presence and introduce modifications for its prevention. Thus, we consider that women in this series, have not displayed significant amounts of urinary ketones during follow-up for GDM or at least, not for long periods.…”

Ketonemia and ketonuria in gestational diabetes mellitus

“…Plasma 3HB during the third trimester of pregnancy is negatively associated with the neuropsychological development of the offspring and has led to the recommendation to avoid ketosis during pregnancy. 11 In recent years a new method has become available to measure capillary levels of 3HB. This test uses the same equipment used for SMBG determination but with specific strips.…”

Insulin Use in Gestational Diabetes – Pragmatic Protocols for Self-Management and for Labour and Delivery

“…Allowing the woman to be responsible for the gradual and persistent adjustments of insulin dose regularly seen in GDM as the placenta continues to grow and her insulin needs rise can facilitate her care. Occasional additional tests in relation to snacks or prior to meals may be necessary to determine glucose control is always good (Montaner, Ripolles, Pamies, & Corcoy, 2011). Visits may be further apart because the woman is making the appropriate adjustments, thus the medical team does not need to.…”