MATERNAL GLYCEMIC CRITERIA FOR INSULIN THERAPY IN GESTATIONAL DIABETES-MELLITUS

In the last decade, it has become clear that gestational diabetes is a clinical entity associated with perinatal mortality and morbidity. Th us, the attention to and management sf gestational diabetes during pre gnancy are mandatory. In this review, results of 58 original studies ( spanning the past 20 years) addressing criteria for insulin management in gestational diabetes were assessed. The level of glycemic control and its evaluation through self-monitoring of blood glucose are the fo undation for ascertaining optimal pregnancy outcome. This review addre sses the criteria for insulin initiation: insulin requirements, identi fication of the right patient, the timing for insulin initiation, and the behavioral adjustment and compliance during insulin therapy It is recommended that patients with fasting plasma glucose on the oral gluc ose tolerance test (OGTT) of <96 mg/dl land ideally nonobese) be assig ned to diet therapy Obese women or those with fasting plasma glucose > 95 mg/dl on the OGTT should be referred to insulin therapy in order to minimize exposure of the fetus to a hyperglycemic environment.