What is the main goal when managing a pregnancy with GDM?

The main goal when managing a pregnancy with gestational diabetes mellitus (GDM) is to monitor for macrosomia and plan delivery timing. This approach derives from the need to prevent complications associated with excessive fetal growth, known as macrosomia, which can occur when maternal blood sugar levels are not well controlled. Macrosomia can lead to various delivery complications, including increased likelihood of cesarean section, birth injuries, and labor complications.

Monitoring the fetus's growth through ultrasounds, adjusting maternal diet and activity to manage blood glucose levels, and timing the delivery appropriately are key strategies in GDM management. The aim is to optimize outcomes for both the mother and the baby by minimizing risks associated with high maternal glucose levels.

Options like initiating insulin immediately or increasing maternal calorie intake don't address the core issue of maintaining optimal blood glucose levels to support healthy fetal growth. Preventing natural delivery is counterproductive, as natural delivery is often the goal unless medical indications suggest otherwise. Thus, focusing on macrosomia prevention and planning delivery timing provides a comprehensive strategy for managing GDM effectively.