Gestational diabetes: current aspects on pathogenesis and treatment

Summary:

Gestational diabetes (GDM) is a carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy. The incidence of GDM is between 0.15-15 %, which corresponds to the prevalence of type 2 diabetes and IGT in a given country. - The predominant pathogenic factor in GDM could be the inadequate insulin secretion. If GDM is not properly treated the risk of adverse maternal (preeclampsia) and fetal (large-for-gestational-age infant, macrosomia, birth trauma, cesarean section, stillbirth) outcome increases. Hypertension is more prevalent in GDM, and GDM is diagnosed more frequently in women with chronic hypertension. - In order to screen for disturbances of carbohydrate metabolism during pregnancy a simple method suitable for all pregnant women would be desirable, however no such method is available at present. According to the latest WHO recommendation the screening for GDM should be performed universally with the standard 75 g oGTT evaluating only the 2-hour blood glucose values or together with the fasting ones. The latter could provide even an exact diagnosis of the carbohydrate metabolic state. - To manage GDM the first step prompt after diagnosis is to educate adequate dietary needs. If the blood sugar values in spite of an adequate diet exceed the desirable target values, insulin treatment has to be initiated. - GDM is a predictor of diabetes (mainly type 2) later in life. The cumulative incidence of type 2 diabetes is about 50 % at 5 years. This review of the current literature including our own experience strongly supposes that prior GDM is also a predictor or even an early manifestation of the metabolic (insulin resistance) syndrome. By all means GDM is a cardiovascular risk factor that could be screened to prevent late complications. The previously presented evidence also strongly suggests that yearly check-ups for women with previous GDM are inevitably important.

Key words:

Gestational Diabetes - pathogenesis - screening - management