How Pharmacists Can Support Women with Gestational Diabetes

Gestational diabetes mellitus (GDM) is characterised by any degree of glucose intolerance (hyperglycaemia) which develops or is first recognised during pregnancy.1 In most cases, it is asymptomatic and diagnosed on routine testing at 24–28 weeks’ gestation. Maternal hyperglycaemia leads to foetal hyperglycaemia and hyperinsulinaemia, which impacts both perinatal and longterm health outcomes in offspring. Adverse outcomes for the offspring include increased birth weight (macrosomia) (OR 1.8 [95% CI 1.7, 1.8]), excess fetal adiposity (per cent body fat), and increased umbilical cord C-peptide (reflects the insulin secretory activity of pancreatic beta cells). A high birth weight may complicate vaginal delivery (e.g. by increasing risk of shoulder dystocia), put the mother and baby at risk of injury from the birthing process, and also leads to a higher rate of delivery by caesarean section (OR 1.4 [95% CI 1.4, 1.4]).4 After delivery, there is an increased risk of neonatal hypoglycaemia. Long-term risks of macrosomia in infants of women with GDM include childhood obesity and an increased risk of cardiovascular disease. As the most accessible health professionals, pharmacists play an important role supporting women with GDM, particularly around blood glucose monitoring, medicine use (if needed), and encouraging lifestyle interventions to optimise both the mother’s and offspring’s short- and long-term health outcomes.