engleski

Pregnancy outcome in patients with optimally treated gestational diabetes mellitus

Pregnancy is characterized by insulin resistance and hyperinsulinemia, thus it may predispose some women to develop diabetes. The resistance stems from placental secretion of diabetogenic hormones, as well as increased maternal adipose deposition, decreased exercise, and increased caloric intake. These and other endocrinologic and metabolic changes ensure that the fetus has an ample supply of fuel and nutrients at all times. Gestational diabetes occurs when pancreatic function is not sufficient to overcome the insulin resistance created by changes in diabetogenic hormones during pregnancy. The term “gestational diabetes” has been used to define women with onset or first recognition of abnormal glucose tolerance during pregnancy. However, in 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG recommended a change to this terminology. In this system, diabetes diagnosed during pregnancy is classified as overt or gestational. The rationale for this change is that an increasing proportion of young women have overt but as yet unrecognized type 2 diabetes due to the increasing prevalence of obesity and lack of routine glucose screening/testing in this age group. Several adverse outcomes have been associated with diabetes during pregnancy: preeclampsia, hydramnios, fetal macrosomia, fetal organomegaly, birth trauma, operative delivery, perinatal mortality, neonatal respiratory problems and metabolic complications (hypoglycemia, hyperbilirubinemia, hypocalcemia, erythremia). There are also potential long-term consequences to the infant, such as development of obesity and diabetes during childhood, impaired fine and gross motor functions, and higher rates of inattention and/ or hyperactivity. For the mother with gestational diabetes, there is a 10 percent likelihood of overt diabetes mellitus immediately after the index pregnancy. The likelihood of developing overt diabetes in the years following the pregnancy has been estimated to be as high as 40 percent within 20 years. Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity, particularly macrosomia. An effective treatment regimen consists of dietary therapy, self blood glucose monitoring, and the administration of insulin if target blood glucose concentrations are not met with diet alone.

pregnancy outcome; gestational diabetes mellitus; treatment

nije evidentirano