How pharmacists can support women with gestational diabetes

Case scenario

Sophie, a 30-year-old pregnant woman, presents to the pharmacy with a prescription for insulin. She has recently been diagnosed with gestational diabetes mellitus and is anxious about administering insulin, as she has only ever taken oral medicines and doesn’t want to take anything to harm her baby.

Introduction

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 fetal hyperglycaemia and hyperinsulinaemia, which impacts both perinatal and long-term health outcomes in offspring.^2,3 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).^2–4

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 cardiovascular disease.^2–5

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 encou