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
