title: Diabetic pregnancy: an overview of current guidelines and clinical practice.
abstract: OBJECTIVE
  We review the recent changes in diagnostic criteria of gestational diabetes mellitus (GDM), describe problems with maintaining and monitoring adequate blood glucose, especially in type 1 diabetes, and provide a brief overview of the currently approved glucose-lowering therapies in pregnancy.
  
  
  RESULTS
  After the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, the definition of GDM was revised under the auspices of the International Association of Diabetes and Pregnancy Study Groups. The guidelines, with minor modifications, were endorsed by WHO in 2013. Intensive debate continues, focused on the expected large increase in prevalence of GDM and shortage of experimental evidence of clinical benefits from the new diagnostic criteria. Despite a very good glycaemic control, the prevalence of macrosomia remains high. This indicates a serious deficiency in current monitoring tools and the available therapies. So far, the only glucose-lowering medications approved for use during pregnancy are insulins.
  
  
  CONCLUSIONS
  The HAPO study provides a very suggestive evidence for a strong, continuous association of maternal glucose levels with an increased risk of excessive foetal weight gain. The new definition of GDM results in higher healthcare expenditure, but remains cost-effective. The current therapeutic goals require careful revision to further reduce the risk of adverse outcomes. New glucose-monitoring strategies and markers, and approval of new pharmacotherapies are needed.
authors.affiliation: aDepartment of Metabolic Diseases, Jagiellonian University, Medical College bUniversity Hospital, Krakow, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Skupień
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Cyganek
authors.forename: Maciej T
authors.initials: MT
authors.lastname: Małecki
mesh_terms: D003131:Combined Modality Therapy; D032921:Consensus; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D003927:Diet, Diabetic; D019317:Evidence-Based Medicine; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D014943:Global Health; D019456:Health Transition; D006801:Humans; D007004:Hypoglycemic Agents / Q000737:chemistry / Q000627:therapeutic use; D061386:Insulin, Regular, Human / Q000031:analogs & derivatives / Q000235:genetics / Q000627:therapeutic use; D039382:Maternal Nutritional Physiological Phenomena; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D011296:Prenatal Diagnosis / Q000639:trends; D011994:Recombinant Proteins / Q000737:chemistry / Q000627:therapeutic use; D012306:Risk
chemical_list: D007004:Hypoglycemic Agents; D061386:Insulin, Regular, Human; D011994:Recombinant Proteins