Abstract
Diabetes in pregnancy, both preexisting type 1 or type 2 and gestational diabetes, is a highly prevalent condition, which has a great impact on maternal and fetal health, with short and long-term implications. Gestational Diabetes Mellitus (GDM) is a condition triggered by metabolic adaptation, which occurs during the second half of pregnancy. There is still a lot of controversy about GDM, from classification and diagnosis to treatment. Recently, there have been some advances in the field as well as recommendations from international societies, such as how to distinguish previous diabetes, even if first recognized during pregnancy, and newer diagnostic criteria, based on pregnancy outcomes, instead of maternal risk of future diabetes. These new recommendations will lead to a higher prevalence of GDM, and important issues are yet to be resolved, such as the cost-utility of this increase in diagnoses as well as the determinants for poor outcomes. The aim of this review is to discuss the advances in diagnosis and classification of GDM, as well as their implications in the field, the issue of hyperglycemia in early pregnancy and the role of hemoglobin A1c (HbA1c) during pregnancy. We have looked into the determinants of the poor outcomes predicted by the diagnosis by way of oral glucose tolerance tests, highlighting the relevance of continuous glucose monitoring tools, as well as other possible pathogenetic factors related to poor pregnancy outcomes.
Highlights
Our goal is to discuss the most current clinical data on gestational diabetes
The potential usefulness of an early hemoglobin A1c (HbA1c) test has been pointed out [21]. It was demonstrated by a large study from New Zealand that HbA1c ≥ 5.9% is an optimal cutoff for identifying women with preexisting but undiagnosed diabetes in early pregnancy, and that it is a marker for adverse pregnancy outcomes [23]
We showed that the main observed differences, which were found in comparisons between NDM and GDM1 groups, were related to higher glucose variability and increased number of excursions above 7.8 mmol/L, while glucose exposure was somewhat similar among the groups
Summary
Our goal is to discuss the most current clinical data on gestational diabetes. A PubMed search up to July 2017 was conducted using the search term “gestational diabetes”, and over 10,000 articles were retrieved. Hyperglycemia in pregnancy is considered a high-risk condition for both the mother and the fetus, and there has been an increasing prevalence of both gestational and preexisting diabetes mellitus (DM) [1]. It has been demonstrated that in utero exposure to either nutrient excess or deprivation affects fetal metabolic programming, resulting in an increased long-term risk of obesity, DM, and cardiovascular diseases during adult life [2]. These are all compelling reasons to adequately treat diabetic pregnancies and disrupt the intergeneration contribution to ongoing obesity and DM epidemics. Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria, hyperglycemia less than overt diabetes in early pregnancy, the role of glycated hemoglobin A1c (HbA1c) in GDM, outcome determinants, as well as treatment target considerations
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