Comments on gestational diabetes mellitus: from pathophysiology to clinical practice

Abstract

Gestational diabetes mellitus (GDM) is a topic of major interest, as it affects up to 16% of pregnant women and may lead to adverse pregnancy outcomes, which, however, are preventable by appropriate treatment. The aim of the present study was to discuss basic concepts and to critically appraise recent updates on practical issues in the field of GDM. GDM pathophysiology, long-term complications including "fetal programming" and GDM diagnosis are discussed, while clinical practice guidelines on follow-up, medical nutrition therapy, oral hypoglycemic agents and insulin treatment are also reviewed. GDM comprises a serious yet preventable public health problem and prevention by lifestyle changes, early detection and adequate treatment can lead to better health outcomes for both mothers with GDM and their offspring.

Association between Maternal Serum Concentrations of Angiopoietin-like Protein 2 in Early Pregnancy and Subsequent Risk of Gestational Diabetes Mellitus

“…In normal pregnancies, there is a physiological insulin resistance from as early as the first trimester, which increases with gestational age. [ 20 21 22 23 24 ] In women with GDM, there is a higher level of fasting blood glucose and insulin, and the insulin sensitivity may decrease by up to 40% in late pregnancy. [ 25 26 ] Although we could not elucidate the mechanism of how ANGPTL2 contributes to GDM pathogenesis, several reports suggested an association between insulin resistance and ANGPTL2.…”

Role of Exercise in Reducing Gestational Diabetes Mellitus

“…6 Much controversy surrounds the diagnosis of GDM because if the IADPSG criteria are adopted universally, a larger proportion of women will be diagnosed, implying new therapeutic challenges and major impact on health care costs to avoid fetal and maternal complications related to the hyperglycemia of GDM. 5 Agarwal 7 recently summarized and compared the differing screening and diagnostic criteria of GDM from around the world and suggested that many international and regional guidelines are lagging behind current research.…”

“…20 The dietary program should restore euglycemia, prevent ketosis, and lead to optimal weight gain, considering possible effects on fetal health. 6 Fetal concerns during a GDM pregnancy are excessive fetal growth and fetal distress that warrants suggested frequent fetal biophysical profiles and ultrasound assessments of fetal growth. 21 MNT and exercise in GDM women have been shown to lower rates of large-forgestational-age infants and macrosomia without increasing small-for-gestationalage babies.…”

“…6 Despite professional endorsement there are only a few wellcontrolled studies examining the role of exercise in combination with MNT in GDM management. One recent study from the Irish Atlantic seaboard reported that GDM women treated with MNT and exercise had fewer macrosomic infants without an increase in small-for-gestational-age babies compared with BMImatched women with normoglycemia.…”

Does being an infant of Gestational Diabetic Mother Affect Cerebellar Size?

“…Gestasyonel diyabet tanısı için iki ayrı zamanda alı-nan açlık kan şekerinin (KŞ) >126 mg/dl olması ya da iki ayrı zamanda rastgele alınan kanda KŞ >200 mg/dl olması koşulu arandı 3. eğer hastaya erken gebelikte diyabet tanısı konmamışsa 24.-28. gebelik haftasında yapılan 2-saatlik 75 g oral glukoz tolerans testinde aç-lık KŞ >92 mg/dl olması ya da 1. saatte KŞ >180 mg/dl ve 2. saatte KŞ >150 mg/dl olması koşulu arandı 15 .…”