Controversies around gestational diabetes. Practical information for family doctors.
OBJECTIVE
To summarize some of the issues facing primary care physicians who are seeing increasing numbers of patients with gestational diabetes mellitus (GDM) and to explore new developments in use of oral hypoglycemics during pregnancy.


METHODS
All the literature on screening for GDM offers level III evidence. Much of the literature on treatment is also level III, but newer studies offer level I evidence and are more useful for daily practice. Existing research leaves many important questions unanswered; research findings are inconsistent among studies, and treatment strategies are challenging to implement.


RESULTS
Recent studies have clarified that rates of neonatal mortality and congenital malformations are not higher among the offspring of mothers with GDM. Treatment might affect birth weight, but whether treatment is associated with reductions in rates of shoulder dystocia and cesarean section is unclear. Several level I studies conclude that the oral hypoglycemic glyburide can be used safely and effectively during the second and third trimesters of pregnancy.


CONCLUSIONS
Management of GDM remains a controversial area in obstetric care. It is a growing area of research, and new developments that might clarify risk and simplify treatment are expected in the coming years.
Kelly
Len
L
McMaster University's Family Medicine North, Sioux Lookout, Ont. lkelly@mcmaster.ca
Evans
Laura
L
Messenger
David
D
D000013:Congenital Abnormalities / Q000209:etiology; D016640:Diabetes, Gestational / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D047109:Fetal Development; D005320:Fetal Macrosomia / Q000209:etiology; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007226:Infant Mortality; D007231:Infant, Newborn; D008403:Mass Screening / Q000379:methods; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000150:complications* / Q000188:drug therapy
D007004:Hypoglycemic Agents