Screening and Management for Gestational Diabetes

Abstract

Gestational diabetes mellitus (GDM) affects 5 % of all pregnancies, making it the most common complication of pregnancy today.' Yet a recent study found that only 41 % of physicians routinely screen pregnant women for diabetes. In addition, fewer than half use the recommended method of diagnosing gestational diabetes.2Gestational diabetes is usually diagnosed during the second half of pregnancy because that is when the mother's insulin needs rise as her body greatly increases the amount of nourishment to the baby. If the mothers pancreas cannot produce enough insulin, or if her insulinis not used effectively, gestational diabetes results.The Second International Workshop -Conference on Gestational Diabetes Mellitus, held in October 1984, defined GDM as &dquo;carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. &dquo;3 This definition applies whether or not insulin is used for treatment and whether or not the condition persists after pregnancy. It does not preclude the possibility that the condition existed prior to the present pregnancy and/or that it may be permanent.In 97.5 % of women diagnosed with gestational diabetes, the condition disappears at the end of the pregnancy.4 However, approximately 60% of women with GDM develop overt diabetes mellitus within 20 years following the pregnancy if they are overweight and remain overweight.4 Maintaining desirable body weight, exercise, and optimal nutrition reduces the likelihood to 25%. is a large birth weight for the baby. This can result in significant injury to the infant and cause trauma to the mother during delivery. It is also one reason for the increased incidence of caesarean sections for women with diabetes mellitus.5 Other risks to the mother and baby are outlined in Table 1. The question of whether congenital anomalies occur more often among infants of women with GDM remains unanswered. ScreeningIn the past, most physicians have attempted to identify women with GDM by defining those at &dquo;high risk&dquo; based on maternal, historical, or clinical risk factors. Such factors include a history of stillbirth or miscarriage, a family member with diabetes, previous delivery of an infant weighing more than 9 lb (4,000 g) at birth, a previous pregnancy complicated by GDM, obesity in the mother, a high maternal age, parity of five or more, and glycosuria, urinary tract infections, hydramnios, or a history of toxemia in the mother. This high-risk group, once identified, is then tested for abnormal carbohydrate metabolism. Recent research has revealed that screening pregnant women on the basis of the above risk factors alone will detect only 50% of all cases of GDM . M any patients diagnosed with GDM exhibit no risk factors. For this reason. the American Diabetes Association recommended in 1985 that all pregnant women be screened for abnormal glucose metabolism between the 24th and 28th weeks of gestation.The correct screening method for gestational diabetes involves giving the pregnant woman a 50-g oral g...

Gestational diabetes mellitus: evidence for autoimmunity against the pancreatic Beta cells

“…After exclusion of these data, there was no difference in insulin binding among any of these groups or between the normal blood donors and any of these groups tions [8]. There has been a downward trend in the acceptable upper limit of normal blood glucose concentration during pregnancy, although there is still disagreement as to the absolute limits that should be imposed [12][13][14][15][16] and, especially, to the criteria for screening pregnant women for glucose intolerance and to the test that should be employed [17][18]. The criteria for screening in our institution and for the introduction of insulin therapy in gestational diabetes have been lowered since the present study was conducted using sera obtained in 1983-1984.…”

Nutrition Update

“…The OGTT requires an overnight fast of 8 to 14 hours.' The test should be preceded by 3 stricted activity and diet (ie, a minimum of 1500 calories per day). The 300-g carbohydrate load diet is not necessary.…”