Gestational Diabetes Mellitus: A Review of the Literature
Selik, Brooke A.
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The rise in obesity rates both in the United States and worldwide has lead to an increase in prevalence of gestational diabetes mellitus (GDM), which is diabetes with onset during pregnancy. While changes in maternal insulin sensitivity are necessary during pregnancy to accommodate the energy requirements of the growing fetus, GDM results from severe insulin resistance for which the mother cannot compensate. Several placental hormones and secreted factors including hPGH and TNF-α have been implicated in GDM pathogenesis because of their known anti-insulin properties. Most pregnant women are tested for GDM with some form of oral glucose tolerance test at 24- 28 weeks’ gestation. However, lack of standardization in screening and diagnosis methods remains a major hurdle in GDM diagnosis and management. Current management options for GDM include blood glucose monitoring, medical nutrition therapy, exercise, and insulin therapy, if necessary. Oral hypoglycemic agents such as metformin and glyburide are being studied for their potential use as therapeutic agents in GDM patients, but their teratogenicity is unclear. Because women with a history of GDM and their children are at increased risk of developing type 2 diabetes later in life, it is crucial that they be monitored closely postpartum. They should also be counseled about the benefits of lifestyle interventions in delaying or preventing the onset of diabetes. More research needs to be done and more steps need to be taken in order to lower GDM prevalence and better the health of these women and their families.