[Gestational diabetes mellitus].
Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations in the diabetic range. In case of a high risk for GDM/type 2 diabetes (history of GDM or prediabetes [impaired fasting glucose or impaired glucose tolerance]; malformation, stillbirth, successive abortions or birth-weight > 4500 g in previous pregnancies) performance of the OGTT (120 min; 75 g glucose) is recommended already in the first trimester and--if normal--the OGTT should be repeated in the second/third trimester. In case of clinical symptoms of diabetes (glucosuria, macrosomia) the test has to be performed immediately. All other women should undergo a diagnostic test between 24 and 28 gestational weeks. If fasting plasma glucose exceeds 95 mg/dl, 1 h 180 mg/dl and 2 hrs 155 mg/dl after glucose loading (OGTT) the woman is classified as GDM (one pathological value is sufficient). In this case a strict metabolic control is mandatory. All women should receive nutritional counseling and be instructed in blood glucose self-monitoring. If blood glucose levels cannot be maintained in the normal range (fasting < 95 mg/dl and 1 h after meals < 130 mg/dl) insulin therapy should be initiated. Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a 75 g OGTT (WHO criteria).
Kautzky-Willer
Alexandra
A
Klinische Abteilung für Endokrinologie und Stoffwechsel, Univ.-Klinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Wien, Osterreich. alexandra.kautzky-willer@meduniwien.ac.at
Bancher-Todesca
Dagmar
D
Birnbacher
Robert
R
D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005313:Fetal Death; D005320:Fetal Macrosomia; D005951:Glucose Tolerance Test; D006029:Glycosuria; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy
D001786:Blood Glucose