Gestational diabetes mellitus: risks and management during and after pregnancy.
Summary of "Gestational diabetes mellitus: risks and management during and after pregnancy."
Gestational diabetes mellitus (GDM) carries a small but potentially important risk of adverse perinatal outcomes and a long-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of developing diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements complement maternal glucose monitoring in the identification of pregnancies that require such intensification. Glucose testing shortly after delivery can stratify the short-term diabetes risk in mothers. Thereafter, annual glucose and HbA(1c) testing can detect deteriorating glycaemic control, a harbinger of future diabetes mellitus, usually type 2 diabetes mellitus. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes mellitus. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning enables optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity.
Affiliation
Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California, 2250 Alcazar Street, CSC 205, Los Angeles, CA 90033, USA.
Journal Details
This article was published in the following journal.
Name: Nature reviews. Endocrinology
ISSN: 1759-5037
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22751341
- DOI: http://dx.doi.org/10.1038/nrendo.2012.96
Medical and Biotech [MESH] Definitions
Diabetes, Gestational
Diabetes mellitus induced by PREGNANCY but resolved at the end of pregnancy. It does not include previously diagnosed diabetics who become pregnant (PREGNANCY IN DIABETICS). Gestational diabetes usually develops in late pregnancy when insulin antagonistic hormones peaks leading to INSULIN RESISTANCE; GLUCOSE INTOLERANCE; and HYPERGLYCEMIA.
Pregnancy In Diabetics
The state of PREGNANCY in women with DIABETES MELLITUS. This does not include either symptomatic diabetes or GLUCOSE INTOLERANCE induced by pregnancy (DIABETES, GESTATIONAL) which resolves at the end of pregnancy.
Fetal Macrosomia
A condition of fetal overgrowth leading to a large-for-gestational-age FETUS. It is defined as BIRTH WEIGHT greater than 4,000 grams or above the 90th percentile for population and sex-specific growth curves. It is commonly seen in GESTATIONAL DIABETES; PROLONGED PREGNANCY; and pregnancies complicated by pre-existing diabetes mellitus.
Diabetes Mellitus, Type 2
A subclass of DIABETES MELLITUS that is not INSULIN-responsive or dependent (NIDDM). It is characterized initially by INSULIN RESISTANCE and HYPERINSULINEMIA; and eventually by GLUCOSE INTOLERANCE; HYPERGLYCEMIA; and overt diabetes. Type II diabetes mellitus is no longer considered a disease exclusively found in adults. Patients seldom develop KETOSIS but often exhibit OBESITY.
Gestational Sac
Round-shaped structure usually located in the upper fundus of the UTERUS in early pregnancy. It comprises EMBRYO; AMNIOTIC FLUID; and YOLK SAC. It is visible in PRENATAL ULTRASONOGRAPHY by the fifth week of pregnancy. Its size is often used to determine and monitor GESTATIONAL AGE; FETAL GROWTH; and PREGNANCY COMPLICATIONS.
PubMed Articles
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