Abstract
Gestational diabetes mellitus (GDM) is defined as an impairment of glucose tolerance, manifested by hyperglycemia, which occurs at any stage of pregnancy. GDM is more common in the third trimester of pregnancy and usually disappears after birth. It was hypothesized that the glycemic status of the mother can modulate liver development and growth early during the pregnancy. The simplest modality to monitor the evolution of GDM employs noninvasive techniques. In this category, routinely obstetrical ultrasound (OUS) examinations (simple or 2D/3D) can be employed for specific fetal measurements, such as fetal liver length (FLL) or volume (FLV). FLL and FLV may emerge as possible predictors of GDM as they positively relate to the maternal glycated hemoglobin (HbA1c) levels and to the results of the oral glucose tolerance test. The aim of this review is to offer insight into the relationship between GDM and fetal nutritional status. Risk factors for GDM and the short- and long-term outcomes of GDM pregnancies are also discussed, as well as the significance of different dietary patterns. Moreover, the review aims to fill one gap in the literature, investigating whether fetal liver growth can be used as a predictor of GDM evolution. To conclude, although studies pointed out a connection between fetal indices and GDM as useful tools in the early detection of GDM (before 23 weeks of gestation), additional research is needed to properly manage GDM and offspring health.
Highlights
Gestational diabetes mellitus (GDM) is a relatively common pregnancy pathological condition that was recently defined by the American Diabetes Association (ADA) as hyperglycemia, with no obvious cause, first appearing or discovered during the pregnancy’s 4.0/).second or third trimester [1–5]
Women should be subjected to thisistest at 24–28 of gestation, of fasting blood glucose or glycated hemoglobin (HbA1c), it has some disadvantages, a recent study showed that GDM diagnosed at 24–28 weeks of gestation has such as high cost and duration, low in reproducibility, and discomfort caused tonecessity the patient already impacted the fetus but only older and obese women, suggesting the of by the high amount carbohydrates that has to be in are a very short period screening before thisof period
The results showed that the mean fetal liver length (FLL) value in the GDM group was 1.6 times the value in the non-GDM group (37.2 mm vs. 33.1 mm; p < 0.001) [5]
Summary
Gestational diabetes mellitus (GDM) is a relatively common pregnancy pathological condition that was recently defined by the American Diabetes Association (ADA) as hyperglycemia, with no obvious cause, first appearing or discovered during the pregnancy’s. Women should be subjected to thisistest at 24–28 of gestation, of fasting blood glucose or glycated hemoglobin (HbA1c), it has some disadvantages, a recent study showed that GDM diagnosed at 24–28 weeks of gestation has such as high cost and duration, low in reproducibility, and discomfort caused tonecessity the patient already impacted the fetus but only older and obese women, suggesting the of by the high amount carbohydrates that has to be in are a very short period screening before thisof period [8]. Metformin should be prescribed with precaution considering that it is not associated with an improvement in insulin sensitivity and there is a need to clarify whether it can cause any harm to the offspring in the long term [44–47] This is worrying given that the offspring of females with untreated GDM are prone to develop obesity, diabetes, and CVD, an important factor that will contribute towards the burden of diabetes reaching 439 million patients worldwide (approximately 70% of adults aged 54–60) by 2030 [2,48]. Insulin has low efficacy due to the degree of peripheral resistance to its action, and the long-term effects of oral antidiabetics, such as metformin or glyburide, both on the mother and the fetus, are not yet fully understood, as they have a high number of side effects, such as maternal weight gain and neonatal hypoglycemia [2,49]
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