title: Unresolved controversies in gestational diabetes: implications on maternal and infant health.
abstract: OBJECTIVE
  Gestational diabetes mellitus (GDM) is a major public health concern because of rising rates and offspring consequences; yet, expert panels are in complete disagreement on how to diagnose and optimally treat GDM. This review underscores why there remains no diagnostic standard, no agreement on whether excess dietary carbohydrate or fat should be reduced, and whether oral hypoglycemic therapy is safe given the unknown offspring effects on hepatic, pancreatic, or fat development.
  
  
  RESULTS
  New diagnostic criteria proposed by the American Diabetes Association would triple the prevalence of GDM (∼18%). Whether the treatment of women with these milder degrees of hyperglycemia will improve pregnancy outcomes is unknown given the powerful effect of obesity alone on excess fetal growth. There are data that restricting carbohydrate in the diet by substituting fat to blunt postprandial glucose levels may worsen maternal insulin resistance and that metformin may increase offspring subcutaneous fat.
  
  
  CONCLUSIONS
  The adoption of the new American Diabetes Association diagnostic criteria for GDM was rejected by ACOG and not endorsed by the NIH. Yet, varying criteria are used by different centers resulting in confusion for both patient care and research. Both maternal diet and agents that cross the placenta could potentially modify offspring gene expression. Better identification and treatment of mothers and fetuses at risk may have far-reaching implications for maternal and child health.
authors.affiliation: Divisions of Endocrinology, Metabolism and Diabetes and Maternal-Fetal Medicine University of Colorado School of Medicine, CO, USA.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Barbour
mesh_terms: D031204:Caloric Restriction; D016640:Diabetes, Gestational; D050528:Diet, Carbohydrate-Restricted; D003927:Diet, Diabetic; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D018507:Gene Expression Regulation, Developmental; D005905:Glyburide / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008430:Maternal-Child Health Centers / Q000458:organization & administration*; D008431:Maternal-Fetal Exchange / Q000502:physiology; D008687:Metformin / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D014481:United States / Q000453:epidemiology
chemical_list: C417231:Glucovance; D007004:Hypoglycemic Agents; D008687:Metformin; D005905:Glyburide