Gestational diabetes – Diagnostic and therapeutic novelties

Abstract

The prevalence of diabetes during pregnancy has been steadily increasing in the US, mainly gestational diabetes (approximately 90% of the cases). The other types of diabetes during pregnancy are type 1 and type 2 diabetes mellitus. Pre-existing type 2 diabetes mellitus represents approximately 8% of all types of diabetes during pregnancy. The increase in the prevalence of gestational diabetes occurred in parallel with the increase in the prevalence of obesity. The diagnosis of gestational diabetes is made either through one-step or two-step strategy in pregnant women between 24 and 28 weeks of gestation. Diabetes screening is also recommended at the first prenatal visit to women with increased risk factors for diabetes. The management of diabetes during pregnancy involves nutritional medical therapy and/ or pharmacological treatment, in order to achieve the glycemic targets that have been associated with the lowest risk of maternal and fetal complications. Considering the possibility of diabetic complications (retinopathy) during pregnancy, the screening of women with pre-existing diabetes is also necessary. Moreover, gestational diabetes has been associated with an increase in the risk of developing maternal type 2 diabetes, in approximately 50-70% of the cases, after the age of 15-25 years. Therefore, it is recommended to test women with gestational diabetes, between 4-12 weeks' post-partum, using the oral glucose tolerance test (OGTT). If the results are normal, the test should be performed every 1 to 3 years.