DETECTION OF GLUCOSE-INTOLERANCE IN PREGNANCY

Current methods for the screening and diagnosis of glucose intolerance first discovered in pregnancy are reviewed and innovative approaches to the detection of metabolic disturbances in pregnancy are presented. Glucose intolerance first detected in pregnancy, termed gestational d iabetes mellitus (GDM), is amongst the most significant risks of adver se fetal and maternal outcome. Normal pregnancy is characterized by bo th insulin resistance and pancreatic B cell compensation. In those pre gnancies complicated by glucose intolerance reflected in hyperglycemia , insulin resistance appears to be heightened, both blood flow and tra nscapillary transport of insulin are compromised and insulin receptor and post receptor defects are exacerbated. The resulting hyperinsuline ma and hyperglycemia have, in turn, been associated with accumulated m aternal fat deposition and fetal macrosomia. This cascade of events co nstitutes GDM or impaired glucose tolerance. The discovery of GDM is m ade through a process of screening and diagnosis, employing standardiz ed oral glucose challenge tests. These tests were designed to identify those women at risk for subsequent development of non-insulin depende nt diabetes mellitus. The current efficacy of glucose challenge tests has been questioned in light of increasing concern over their usefulne ss in detecting those women at risk for maternal and fetal complicatio ns of pregnancy. Alternative methods, including both the modification of the standardized tests, as well as the introduction of newer method ologies, such as capillary blood glucose monitoring, have been propose d. The implementation of newer approaches may result in improved detec tion of those women whose infants are at high risk for both metabolic and morphologic complications of persistent hyperglycemia in pregnancy .