Rationale for prevention and treatment of glucose-mediated macrosomia: a protocol for gestational diabetes.
OBJECTIVE
To formulate a rationale for preventing and treating hyperglycemia during pregnancy and the concomitant risk of macrosomia.


METHODS
We reviewed pertinent studies in the literature and personal experience with patients who had gestational diabetes. In addition, dietary and exercise interventions in the management of such patients were assessed.


RESULTS
During pregnancy, sequential hormonal increases occur to provide glucose substrate to the fetus. When a pregnant woman has a limited insulin secretory capacity and cannot produce enough insulin to compensate for the effect of diabetogenic hormones, gestational diabetes occurs (usually during the second trimester). Maternal hyperglycemia reportedly increases fetal secretion of insulin, and fetal hyperinsulinemia may predispose the fetus to macrosomia. Thus, metabolic abnormalities associated with diabetes during pregnancy result in long-term effects on the offspring, including insulin resistance, obesity, and diabetes, which in turn may contribute to transmission of risk for development of the same problems in subsequent generations. Insulin therapy, dietary measures, and exercise have helped to achieve euglycemia in patients with gestational diabetes.


CONCLUSIONS
Universal screening for gestational diabetes is optimally performed at 26 weeks of gestation. Treatment of diagnosed cases, by insulin, diet, and exercise regimens, will decrease the occurrence of glucose-related macrosomia, improve the outcome of the pregnancy, and reduce the risks for obesity, hypertension, and diabetes in future progeny.
Jovanovic-Peterson
L
L
Sansum Medical Research Foundation, Santa Barbara, California 93105, USA.
Peterson
C M
CM