Changing trends in management of gestational diabetes mellitus

Abstract

Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome.

Gestational Diabetes Mellitus: New Diagnostic Criteria

“…Studies on the association of vitamin D deficiency and higher incidence of GDM have been carried out. Vitamin D at normal levels (higher than 30 ng/ml) is associated with a lower insulin resistance [13].…”

“…Exercise is responsible for improving glycemic control in women with GDM, but also plays an important role on preventing the development of GDM [14]. Probiotics and vitamin D are being subject of studies regarding GDM prevention or treatment, without any evidence of efficacy so far [13].…”

“…The most commonly used are Lactobacillus rhamnosus and Bifidobacterium lactis [13]. Probiotics and vitamin D are being subject of studies regarding GDM prevention or treatment, without any evidence of efficacy so far [13].…”

“…The GDM treatment is adjusted according to the needs of each patient [12]. Diets with a high intake of dietary fiber reduce the risk of developing GDM [13]. Exercise has an important role on glycemic control and thus may prevent, reduce or delay the need for insulin.…”

“…The intake of dietary fiber reduces appetite and thus reduces the total energy consumption, delays gastric emptying, and decreases glucose uptake. The ideal diet is the one that includes chicken, fish, fruits, vegetables and green leaves [13].…”