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At 20 weeks a copy of the antenatal records (including all blood work and ultrasound results) is to be sent to the labour and delivery team/provider(s).Document the sharing of records in the client's chart.Perform a 50 g oral gestational diabetes screen (GDS) followed by a plasma glucose level measured 1 hour later. If the GDS result is 7.8-10.2 mmol/L or if GDM is strongly suspected (before the GDS is completed), perform the 75 g oral glucose tolerance test (GTT).It is a screening and a diagnostic test that requires fasting for more than 8 hours prior to the test.Recent Health Canada recommendations for iron supplementation in pregnancy suggest a supplement that provides 16-20 mg daily.However, the majority of prenatal vitamins (for example, Centrum, Materna) contain 27 mg of iron.Arrange a consultation with the physician once per trimester if possible and as necessary if an abnormality is identified or suspected.

The main practical concern is that women may stop taking supplemental iron because of gastrointestinal discomfort associated with higher amounts of iron.

Thereafter, consult a physician if: failure to gain weight or weight loss present; client is symptomatic; pre-meal glucose levels cannot be maintained below 5.3 mmol/L within 2 weeks of treatment with nutrition therapy; or any complications are identified.

All women with GDM should have a 75 g oral GTT between 6 weeks and 6 months postpartum and when planning a future pregnancy to rule out type 2 diabetes.

Woman who develop GDM have an increased risk of developing type 2 diabetes later in life.

Of Aboriginal women who are diagnosed with GDM, up to 70% will develop type 2 diabetes.

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Supplements containing 16-20 mg of iron are available but are not specifically targeted to pregnant women and are not currently covered by NIHB.

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