OBJECTIVEUp to 30% of women with recent gestational diabetes mellitus (GDM) remain glucose intolerant after delivery. However, the rate of postpartum oral glucose tolerance tests (ppOGTTs) is low. Our aim in this study was to develop a model for risk assessment to target women with high risk for postpartum diabetes.RESEARCH DESIGN AND METHODSIn 605 Caucasian women with GDM, antenatal obstetrical and glucose data and the glucose data of the ppOGTTs performed 13 weeks (median) after delivery were prospectively collected.RESULTSA total of 132 (21.8%) women had an abnormal ppOGTT (2.8% impaired fasting glucose, 13.6% impaired glucose tolerance, and 5.5% diabetes). Independent risk factors were BMI ≥30 kg/m2 (prevalence of abnormal ppOGTT 36.0 vs. 17.3%), gestational age at diagnosis <24 weeks (32.4 vs. 18.0%), 1-h antenatal value >200 mg/dl (11.1 mmol/l) (35.2 vs. 14.8%), and insulin therapy (30.3 vs. 14.5%). The prevalence of an abnormal ppOGTT was assessed according to the number of risk factors: 0, 9.2% (14 of 153); 1, 13.4% (25 of 186); 2, 28.5% (43 of 151); 3, 45.6% (26 of 57); and 4, 68.4% (13 of 19). Subjects were divided according to a significant increase of prevalence and risk for a ppOGTT: low risk (59.9% of subjects), <2 risk factors, 11.6%, odds ratio 1.3; intermediate risk, 2 risk factors, 28.5%, 4.0; and high risk, >2 risk factors, 51.3%, 10.5. The intermediate/high-risk group included 86.6% of those with diabetes and 67% of all those with abnormal ppOGTTs.CONCLUSIONSWomen with ≥2 risk factors have a high risk for an abnormal ppOGTT, and 86% of postpartum diabetes is diagnosed within this group. Targeting women for ppOGTTs based on a risk assessment using available antenatal risk factors might reduce the number of missed cases of postpartum diabetes.

This practice guideline on gestational diabetes is a treatment oriented short version of the evidence based guideline that can be viewed in the internet. It replaces the DDG and DGGG recommendations of 2001 for diagnostic and therapy of gestational diabetes. A complete rework had become necessary in view of epidemiologically based diagnostic criteria, which had been derived from the Hyperglycaemia and Adverse Pregnancy Outcome study (HAPO) by international consensus, and in view of randomised therapy and observation studies published after 2001. With this, Germany has adopted the international standard. Screening and diagnosing gestational diabetes by means of blood glucose are part of the legally binding maternity guidelines in Germany since March 3, 2012. Definition ! Gestational diabetes mellitus (GDM, ICD-10: 024.4G) is defined as a glucose tolerance disorder which is first diagnosed in pregnancy with a 75 g oral glucose tolerance test (OGTT) under standardised conditions with a quality controlled measurement of venous plasma glucose. Diagnosis is possible with a single elevated glucose level. One the other hand, the definition of manifest diabetes during pregnancy is based on criteria that applies outside of pregnancy; that is, manifest diabetes during pregnancy is not classified as GDM. Pathophysiology, Health Objectives ! GDM is usually described as a functional disorder marked by increasing insulin resistance with declining beta cell compensation. Its pathophysiology is similar to that of type 2 diabetes to a large extent. The frequency of poor pregnancy outcomes in women with GDM can be reduced by timely diagnosis and appropriate treatment. Epidemiology ! According to the perinatal statistics, GDM prevalence in Germany rose from 3.7 % in 2010 to 4.3 % in 2012 (roughly 28 200 cases in 2012). Consequences ! Acute Consequences for the Mother There are increased risks for ▶ urinary tract and vaginal infections with resultant increased premature birth rates, ▶ gingivitis, ▶ preeclampsia, ▶ inductions of labour, ▶ fetal macrosomias, ▶ cesarean sections, ▶ shoulder dystocias, ▶ perineal tears, and ▶ post partum bleeding requiring a blood transfusion. Long-Term Consequences for the Mother Diabetes Risk in Later Life The number of women with GDM who develop diabetes within 10 years after the pregnancy is 35-60 % compared to women without GDM. This constitutes a 7 to 10-fold increase of risk. In the first year after the pregnancy, some 20 % of these women develop various forms of abnormal glucose metabolism. The risk is increased with preconceptional obesity, a GDM diagnosis before

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Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. It affects 3-15% of women, depending on the background diabetes risk of the population and applied diagnostic criteria. GDM is associated with neonatal problems such as macrosomia and neonatal hypoglycemia as well as a long term increased risk of diabetes and obesity of offspring. Current therapy of GDM focuses on tightly controlling maternal glucose levels, resulting in insulin therapy in up to 50% of women to reach the fasting glucose target of< 90 mg/dl and 2h-postprandial glucose < 120 mg/dl. However, the rate of macrosomia and C-sections remains increased in pregnancy with GDM despite therapy. This review introduces the diagnosis and implications of GDM and then examines two strands of research aimed at improving current therapy: first, research into predictive markers of GDM pregnancies requiring intensified insulin therapy, and second, research into hypoglycaemic agents for therapy or even prevention of GDM in high risk women such as women with polycystic ovarian syndrome. Predictive markers include amniotic fluid insulin, which requires an invasive amniocentesis procedure, and measures of fetal abdominal circumference early in the third trimester, which have successfully been used to reduce rates of macrosomia. Potential hypoglycemic agents include glyburides and metformin, which have been shown not to have adverse outcomes on neonates, although oral agents are generally contra-indicated because of possible teratogenic and toxic effects observed in animal studies and missing long term outcome data.

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