Gestational Diabetes: A Review of the Current Literature and Guidelines

Gelre Ziekenhuis, Apeldoorn, Gelderland, Netherlands
Obstetrical and Gynecological Survey (Impact Factor: 1.86). 03/2007; 62(2):125-36. DOI: 10.1097/01.ogx.0000253303.92229.59
Source: PubMed


Despite large numbers of original research studies spanning 4 decades there is still no consensus on the subject of gestational diabetes. Should all pregnant women be screened or only those with risk factors? Or is it safe not to screen at all? Which screening test and which diagnostic test are the most reliable? Which cutoff values should we use? What are the risks involved for mother and baby and can treatment improve outcome? What is the connection between gestational diabetes and diabetes mellitus type II? Are there disadvantages to screening? A review of relevant articles shows that definitive answers to these questions are not yet available. There is no gold standard screening test and no threshold glucose value above which complications are markedly increased. On the contrary, there appears to be a continuum of slowly increasing risks with rising blood glucose values, where it seems difficult to draw a clear line between pathology and physiology. Moreover, treatment has thus far not been shown to significantly improve outcome. There seems to be an indistinct area between the diagnosis of gestational diabetes and diabetes mellitus type II, where women with risk factors for one are also predisposed to develop the other, thereby confusing the diagnosis. Finally, the disadvantages to diagnosing and treating women without a clearly proven benefit seem to be significant. Therefore it seems defensible to suspend all screening and treatment for gestational diabetes, or at least significantly raise the threshold for making a positive diagnosis and initiating treatment, until further research has proven a clear benefit. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize that there is still no worldwide consensus on the diagnosis, management, and adverse effects of Gestational Diabetes Mellitus (GDM); explain that all methods of screening vary in sensitivity and depend on very strict preparations for screening; state that there is no agreement on ideal levels of blood glucose to prevent untoward effects; and recall that there are two very large prospective studies that clarify the dark waters and that we should await their results.

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Available from: K.M. Paarlberg, Apr 24, 2015
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    • "In the USA, more than one million pregnancies each year result in adverse outcomes that increase maternal and infant morbidity [31] [32] [33] [34] [35] [36]. Even if only few investigations have focused on this issue, emerging evidence indicates that conditions of sleep loss may have a role in adverse outcome of pregnancy. "
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    ABSTRACT: Objectives Short sleep duration, poor sleep quality, and insomnia frequently characterize sleep in pregnancy during all three trimesters. We aimed to review: (i) the clinical evidence of the association between conditions of sleep loss during pregnancy and adverse pregnancy outcomes; and (ii) to discuss the potential pathophysiological mechanisms that may be involved. Methods A systematic search of cross-sectional, longitudinal studies, using Medline, Embase, and PsychINFO, using MeSH headings and key words for conditions of sleep loss such as ‘insomnia’ or ‘poor sleep quality’ or ‘short sleep duration’ and ‘pregnancy outcome’ was made for papers published between January 1, 1960 and July 2013. Results Twenty studies met inclusion criteria for sleep loss and pregnancy outcome: seven studies on prenatal depression, three on gestational diabetes, three on hypertension, pre-eclampsia/eclampsia, six on length of labor/type of delivery, eight on preterm birth and three on birth grow/birth weight. Two main results emerged: (i) conditions of chronic sleep loss are related to adverse pregnancy outcomes; (ii) chronic sleep loss yields a stress-related hypothalamic–pituitary–adrenal axis and abnormal immune/inflammatory, reaction, which, in turn, influences pregnancy outcome negatively. Conclusion Chronic sleep loss frequently characterizes sleep throughout the course of pregnancy and it may contribute to adverse pregnancy outcomes. Common pathophysiological mechanisms emerged as being related to stress system activation. We propose that according to the allostatic load hypothesis, chronic sleep loss in pregnancy may also be regarded as both a result of stress and as a physiological stressor per se, leading to stress ‘overload’. It may account for adverse pregnancy outcomes and somatic and mental disorders in pregnancy.
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    • "The increased insulin resistance during pregnancy has been, as just described, attributed to cortisol and gestational hormones, but more recent data have shown that cytokines may also be involved in this process [6]. The most significant maternal risk is that of development of metabolic syndrome characterized by central obesity, dyslipidemia, and insulin resistance, which predispose to increased risk for coronary artery disease, stroke, and type 2 diabetes later in life [7] [8] [9] [10] [11]. "
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    ABSTRACT: The prevalence of gestational diabetes mellitus (GDM) in the developed world has increased at an alarming rate over the last few decades. GDM has been shown to be associated with postpartum diabetes, insulin resistance, hypertension, and dyslipidemia. A history of previous GDM (pGDM), associated or not with any of these metabolic abnormalities, can increase the risk of developing not only type 2 diabetes mellitus but also cardiovascular disease (CVD) independent of a diagnosis of type 2 diabetes later in life. In this paper we discuss the relationship among inflammatory markers, metabolic abnormalities, and vascular dysfunction in women with pGDM. We also review the current knowledge on metabolic modifications occurring in normal pregnancy and the link between alterations of a normal metabolic state with the long-term maternal complications that may result in increased CVD risk. Our review of studies on pGDM prompts us to recommend that these women be considered a population at risk for later CVD events, which however could be avoided via the use of specially designed follow-up programs in the future.
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    • "In rat placenta, BuChE activity on gestational day 21 reached 150% of the level on gestational day 16. BuChE detoxifies anticholinesterases (AC) and other toxins including free radicals that are known to threaten pregnancy (Hollander et al 2007, Maxwell et al 1997, Osawa and Kato 2005, Twardowska- Saucha et al 1994). There is evidence that Kuwaiti women experiencing disorders of pregnancy like preeclampsia and diabetes mellitus in pregnancy exhibited lower serum activity of BuChE (Mahmoud et al 2003, Mahmoud et al 2006, Mahmoud et al 2008). "

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