Early recognition of gestational diabetes (Introduction of new guidelines and practice) – how should the routines be?

Diabetes in pregnant women may be pregestational, where the diabetes, type 1 or type 2 was diagnosed before pregnancy, or hyperglycemia can be first recognised during the pregnancy that comprise two distinct categories gestational diabetes mellitus (GDM) and previously unrecognised prepregnancy diabetes, so called »overt« diabetes (1) . Women who are in poor glycemic control during the period of fetal organogenesis, which is nearly complete by twelfth week postconception, have a high incidence of spontaneous abortion and fetuses with congenital anomalies . The risk increase exponentially with increasing glycosylated haemoglobin (HbA1c) . On the other hand, the malformation rates are similar to the background population of around 2% when the early pregnancy HbA1c is within normal range (2) . Therefore, importance of preconceptional evaluation and counselling of women with pregestational diabetes mellitus cannot be overstated . Later in pregnancy, poor glycemic control increases the risk of macrosomia and its sequelae by two to four times (3,4,5) . Additionally, perinatal mortality rates (stillbirths and first-week neonatal deaths) among women who are diabetic remain approximately two to four time higher as those observed in the nondiabetic population, and perinatal morbidity (neonatal hypoglycemia, respiratory distress, hyperbilirubinemia and jaundice, hypocalcaemia, hypomagnesaemia, polycythemia, transient hypertrophic cardiomyopathy with congestive cardiac failure) is higher as well (2,5) . In addition to fetal complications, pregnancy in women with pregestational diabetes can adversely influence maternal health . In particular, women can suffer from treatment-induced hypoglycemia and worsening of pre-existing microand macro-vascular complications, such are retinopathy, nephropathy, neuropathy and cardiovascular disease (2) . Gestational hypertension and pre-eclampsia are two to twelve times more common (3,4,5) . Finally, the long-term impact on offspring of exposure to hyperglycemia in utero result in a greater risk of obesity, metabolic syndrome and type 2 diabetes later in life, due to epigenetic modifications of gene expression (2) . Early recognition of overt diabetes in pre-pregnancy unrecognized type 2 diabetic women, and recognition of gestational diabetes with undelayed achievement of normoglycemia is therefore crucial for optimizing maternal and fetal outcomes in all women with hyperglycaemia during pregnancy, regardless of the type of diabetes .