More than 8 million women in the United States have gestational diabetes mellitus (GDM); it is observed in 7% of all pregnancies.¹ The American Diabetes Association (ADA) position statement on the Diagnosis and Classification of Diabetes Mellitus lists GDM or delivery of a baby weighing > 9 lb as a risk factor for developing diabetes later in life.² Women who have had a pregnancy complicated by GDM are 40–60% more likely to develop diabetes within 15–20 years.^3,4 Other risk factors for developing diabetes include a family history of type 2 diabetes, the degree of abnormality of the glucose tolerance test, the degree of obesity, and certain ethnicities.⁵ Table 1 lists risk factors for developing type 2 diabetes. It is important for health care providers to take a proactive approach to create awareness in women with GDM that their own and their child's lifelong risk for developing type 2 diabetes is increased.

In addition to creating awareness, regular follow-up, including testing for pre-diabetes and diabetes, should be promoted on an ongoing basis after a pregnancy that is complicated by GDM. If overweight, women with a history of GDM should be counseled to reduce their risk for diabetes through lifestyle changes and medications if necessary. Children of women with a history of GDM should also be encouraged to establish and maintain healthy lifestyles to avoid excess weight gain and reduce their risk for type 2 diabetes.

This article describes a program that addresses both the diabetes medical nutrition therapy and diabetes self-management education (DSME) needs of women with GDM while integrating information about how to reduce the risk of developing diabetes later in life.

Background

The Joslin Diabetes Center (JDC), an education affiliate at Swedish Medical Center, is located …