Gestational diabetes: current aspects on pathogenesis and treatment

Gestational diabetes (GDM) is a carbohydrate intolerance resulting in hyper glycaemia of variable severity with onset or first recognition during pregn ancy. The incidence of GDM is between 0.15-15%, which corresponds to the pr evalence of type 2 diabetes and IGT in a given country. - The predominant p athogenic factor in GDM could be the inadequate insulin secretion. If GDM i s not properly treated the risk of adverse maternal (preeclampsia) and feta l (large-for-gestational-age infant, macrosomia, birth trauma, cesarean sec tion, stillbirth) outcome increases. Hypertension is more prevalent in GDM, and GDM is diagnosed more frequently in women with chronic hypertension. - In order to screen for disturbances of carbohydrate metabolism during preg nancy a simple method suitable fo; all pregnant women:would be desirable, h owever no such method is available at present. According to the latest WHO recommendation the screening for GDM should be performed universally with t he standard 75 g oGTT evaluating only the 2-hour blood glucose values or to gether with the fasting ones. The latter could provide even an exact diagno sis of the carbohydrate metabolic state. - To manage GDM the first step pro mpt after diagnosis is to educate adequate dietary needs. If the blood suga r values in spite of an adequate diet exceed the desirable target values, i nsulin treatment has to be initiated. GDM is a predictor of diabetes (mainl y type 2) later in life. The cumulative incidence of type 2 diabetes is abo ut 50% at 5 years. This review of the current literature including our own experience strongly supposes that prior GDM is also a predictor or even an early manifestation of the metabolic (insulin resistance) syndrome. By all means GDM is a cardiovascular risk factor that could be screened to prevent late complications. The previously presented evidence also strongly sugges ts that yearly check-ups for women with previous GDM are inevitably importa nt.