Intensified versus conventional management of gestational diabetes

Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus

“…GDM represents nearly 90% of all pregnancies complicated by diabetes (94). Clinical recognition of GDM is important because therapy, including medical nutrition therapy, insulin when necessary, and antepartum fetal surveillance, can reduce the well-described GDM-associated perinatal morbidity and mortality (95). Maternal complications related to GDM also include an increased rate of cesarean delivery and chronic hypertension (95)(96)(97).…”

“…Clinical recognition of GDM is important because therapy, including medical nutrition therapy, insulin when necessary, and antepartum fetal surveillance, can reduce the well-described GDM-associated perinatal morbidity and mortality (95). Maternal complications related to GDM also include an increased rate of cesarean delivery and chronic hypertension (95)(96)(97). Although many patients diagnosed with GDM will not develop diabetes later in life, others will be diagnosed many years Committee Report postpartum as having type 1 diabetes, type 2 diabetes, IFG, or IGT (98 -103).…”

Role of patient education level in predicting macrosomia among women with gestational diabetes mellitus

“…However, not all studies have shown a reduction in risk of macrosomia among gestational diabetics who have received treatment. 5,13,14 Part of this failure may be related to the relatively complex requirements necessary for patient understanding and compliance with the prescribed treatment regimens. Such regimens may include the practice of appropriate diet and exercise, the selfadministration of insulin and home glucose monitoring from fourto-seven times daily.…”

Goals of Metabolic Management of Gestational Diabetes

“…The goal of management in pregnancy complicated by diabetes is to maintain blood glucose as near to normal as possible (5). Various methods of glucose monitoring (urine strips, plasma, capillary, and, more recently, continuous glucose monitoring) as well as different timing have been proposed, including the measurement of fasting, preprandial, postprandial, and mean 24-h blood glucose concentrations (1,6,7).…”

“…The main issue in treating GDM still remains: what glycemic target should be used? Confusing this issue, different approaches for glycemic profile characteristics for treatment assessment are used by different diabetic management pro- grams (i.e., fasting, preprandial, postprandial, and mean 24-h blood glucose concentrations [1,5,6]). Additionally, several authors have emphasized the importance of postprandial glucose determinations and pregnancy outcome, especially macrosomia (8,9).…”