Benefits and Harms of Treating Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research

Abstract

Treating GDM results in less preeclampsia, shoulder dystocia, and macrosomia; however, current evidence does not show an effect on neonatal hypoglycemia or future poor metabolic outcomes. There is little evidence of short-term harm of treating GDM other than an increased demand for services.

Diabetes gestacional - Otimização do controlo materno e morbilidade neonatal

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Engloba um espetro alargado de intolerância à glicose, desde a diabetes prévia à gravidez não identificada até formas ligeiras de intolerância. 6,16,17 Na gravidez ocorre um estado de resistência à ação da insulina, semelhante ao que acontece na diabetes tipo 2.…”

“…2, 3,5,7,8,12,[17][18][19] O aumento da glicemia materna ao induzir hiperglicemia fetal e consequente hiperinsulinismo é considerado responsável pela maioria das complicações fetais associadas à DG. 5,7,16,17,[20][21][22][23] É atualmente entendida como uma das doenças associada à gravidez com maior taxa de complicações.…”

12. Management of Diabetes in Pregnancy

“…Treatment has been demonstrated to improve perinatal outcomes in two large randomized studies as summarized in a U.S. Preventive Services Task Force review (18). Insulin is the first-line agent recommended for treatment of GDM in the U.S.…”

Screening For Gestational Diabetes Mellitus

“…Before 28 weeks fetal growth acceleration has already began,so screening after 28 weeks isn't logical. For healty women without anamnestic risk factors GDM screening and diagnosis is performed between 24 and 28 weeks [7,[38][39][40].…”

“…If GDM is unrecognized or left unregulated, there is an important risk of maternal, fetal and neonatal implications, including increased maternal weight gain, a higher rate of caesarean section, preeclampsia, shoulder dystocia and other birth traumas, macrosomia of newborn, and neonatal hypoglycemia, among others [6]. All these perinatal complications can be prevented or reduced, if the hyperglicaemia is diagnosed early enough [7,8]. During pregnancy, hyperplasia of the pancreatic β-cells occurs, leading to increased insulin secretion, and an early increase in insulin sensitivity is followed by progressive insulin resistance due to the placental secretion of diabetogenic hormones, including growth hormone, corticotropin-releasing hormone, placental lactogen, and progesterone.…”