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PubMed · 14722977

[Gestational diabetes].

Pierre Fontaine
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Abstract

Gestational diabetes represents 6% of all pregnancies and appears even in women without risk factors. This is in favour of a systematic screening between 24th and 28th weeks of gestation. There is as yet still no consensus concerning screening and diagnosis criteria but in France the guidelines are a two step approach: an O'Sullivan test > or = 7.15 mmol/L and a 100 g oral glucose tolerance test (OGTT). Gestational diabetes is defined by 2 or more abnormal values of the OGTT (Carpenter and Coustan criterias). Gestational diabetes has feto-maternal implications: on the one hand gravid hypertension and caesarean section, on the other hand macrosomia, respiratory distress and metabolic complications. The therapeutic management is first diet but insulin therapy is necessary in 40% of cases to obtain glycemic control. During the second part of pregnancy, to obtain a normoglycaemia can decrease and even normalise the rate of feto-maternal complications. Long-term management of women with gestational diabetes and treatment modalities also require better definition, since these patients are at risk for diabetes, mainly type 2. Diabetologists have to set prevention programs up.

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Diabetes, GestationalFemaleHumansPregnancyRisk FactorsEnglish AbstractJournal ArticleReview

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Pierre Fontaine. 2003-11-15. [Gestational diabetes].. https://pubmed.ncbi.nlm.nih.gov/14722977/

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Diabetes, Gestational↗
PubMed2007

Gestational diabetes: a review of the current literature and guidelines.

UNLABELLED: 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.

Diabetes, Gestational↗