[Diagnosis and treatment of gestational diabetes--the Graz model].
OBJECTIVE
Despite the fact that gestational diabetes mellitus (GDM) is a common problem in pregnancy, a good proportion of cases of GDM is either not recognized or treated only inadequately. The main problems are a general trend of underestimating the risk of morbidity, the lack of integration into obstetric care regulations and heterogeneous guidelines regarding the screening and treatment of GDM.


METHODS
For decades, the Graz concept of diagnosis and therapy of GDM has offered a 1-step general screening of all pregnant women between gestational weeks 24 and 28; in addition, the option of measuring the amniotic fluid insulin concentration via amniocentesis at gestational weeks 31-32 allows to detect hyperinsulinemic fetuses who represent an obstetric high-risk group.


CONCLUSIONS
Lower cutoff levels in the oral glucose challenge test as well as the measurement of amniotic fluid insulin concentrations, which have been implemented in the Graz model for a long time, offer a higher detection rate of GDM and allow a targeted therapy of fetuses at high risk. Screening and therapy of GDM are cost-effective instruments to improve obstetric outcomes, therefore obligatory screening and treatment for GDM should be recommended emphatically.
Klinische Abteilung für Geburtshilfe, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Auenbruggerplatz 14, Graz, Austria. thomas.panzitt@medunigraz.at
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D000649:Amniocentesis; D000653:Amniotic Fluid / Q000737:chemistry; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000628:therapy*; D042241:Early Diagnosis; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood; D008403:Mass Screening; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018566:Pregnancy, High-Risk; D011296:Prenatal Diagnosis / Q000379:methods*
D007328:Insulin