Perspectives in Gestational Diabetes Mellitus: A Review of Screening, Diagnosis, and Treatment

Gestational diabetes mellitus (GDM) is a common disorder affecting ~ 7% of pregnancies each year. It can have a much higher incidence in certain minority populations with a greater predisposition to diabetes. The disorder is characterized by carbohydrate intolerance that begins or is first recognized during pregnancy. The prevalence of GDM varies in direct proportion to the prevalence of type 2 diabetes for a given ethnic group or population. When and how to screen for GDM has been debated in the literature for decades. Several studies have suggested grouping patients by low, moderate, and high risk for developing GDM. Currently, and after extensive deliberation, universal screening of all pregnant women is recommended by some groups; however, the American Diabetes Association (ADA) recommends screening of only moderateand high-risk pregnancies. Recognizing and treating GDM results in lowering of maternal and fetal complications. Patients with GDM are at higher risk for excessive weight gain, preeclampsia, and cesarean sections. Infants born to mothers with GDM are at higher risk for macrosomia, birth trauma, and shoulder dystocia. After delivery, these infants have a higher risk of developing hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome, polycythemia, and subsequent obesity and type 2 diabetes. In addition, having a history of GDM puts the mother at risk for development of type 2 diabetes or recurrent GDM in the future. Some recent data suggest an increased risk of cardiovascular disease, as well.