Goals of Metabolic Management of Gestational Diabetes

Seventy two-hour glucose monitoring profiles in mild gestational diabetes mellitus: differences from healthy pregnancies and influence of diet counseling

“…Although we understand that our study design, recruiting different patients to the CGM1 and CGM2 groups, is not ideal for evaluating changes due to dietary counseling, the disappearance of all statistical differences when 175:3 207 Clinical Study M P Carreiro and others GDM changes in glucose profiles comparing the groups to pregnant control subjects using a relatively small sample reinforces the importance of dietary counseling for glucose control in pregnancy. However, the authors caution that the flattening of glucose variability here observed in the GDM2 group related to dietary counseling might not be enough to favorably affect perinatal outcomes in all patients, due to the importance of other confounders besides glucose, such as obesity, lipids, cytokines, among others (22,23). Future studies should possibly address these changes in the same patients, before and after dietary counseling, although we recognize that it could limit the patient sample according to the protocol (16).…”

Gestational Diabetes Mellitus: a review of the diagnosis, clinical implications and management

“…HbA1c levels did not adequately separate women with normal pregnancy from those with GDM, and HbA1c levels decline in normal pregnancy [26]. HbA1c correlated with rates of congenital anomalies and early fetal deaths in pregnant women with pre-existing diabetes, but its role in assessing women with GDM is unclear [5,27]. Most studies found poor to low correlation between glycosylated hemoglobin and mean, fasting, pre-meal, and post-meal blood glucose values.…”

“…In first trimester as well as early in second trimester, an increase in insulin sensitivity occurs mainly due to the relatively higher levels of estrogens. However, in the late second and early third trimesters, the increase release of hormones including human placental lactogen, leptin, prolactin, and cortisol from the placenta are responsible for the increase in insulin resistance [5]. When the woman's insulin secretory capacity cannot cope with the increase in demand, glucose intolerance develops.…”

“…Inclusion of fetal growth might provide the opportunity to reduce glucose testing in low-risk pregnancies. The problem of this approach is that it does not take into account of genetic factors which are important determinants of fetal size [5]. Furthermore, most of the fetal ultrasound measurements are not corrected for the ethnicity of the parents and may have a wide error margin.…”

Insulin Resistance in the Third Trimester of Pregnancy Suffering from Gestational Diabetes Mellitus or Impaired Glucose Tolerance

“…In fact there are significant alterations in glucose metabolism during pregnancy (Catalano, 1994). The carbohydrate tolerance is reduced, especially in the last trimester due to reduced sensitivity to insulin action (Hod &, Yogev, 2007). Insulin resistance is defined where a normal or elevated insulin level produces an attenuated biological response classically this refers to impaired sensitivity to insulin mediated glucose disposal (Wilcox, 2005).…”