title: Treating diabetes during pregnancy.
abstract: BACKGROUND
  Gestational diabetes mellitus (GDM), defined as glucose intolerance with first recognition or onset during pregnancy, is steadily rising in prevalence. GDM affects ∼ 3 - 5% of pregnancies in the US and is associated with significant adverse perinatal and maternal outcomes. Diagnosing and treating GDM early in pregnancy is of utmost importance as it can prevent poor outcomes such as macrosomia, shoulder dystocia and obstetric complications.
  
  
  METHODS
  This review describes the importance of treating GDM and the various available interventions for glycemic control in women with GDM, including the latest evidence regarding pharmacological treatments and specifically anti-hyperglycemic agents. It deals with timing of pharmacological treatments, recommended doses and what pharmacological agent should be used.
  
  
  CONCLUSIONS
  Unless diagnosed late during pregnancy, a stepwise approach is the best way to treat GDM, beginning with diet and exercise and proceeding to pharmacological interventions if failure occurred. Although insulin is the dominant treatment, the use of anti-hyperglycemic agents such as glyburide and metformin in treating GDM has gained popularity and consideration should be made using these agents as first-line pharmacological treatment. Anti-hyperglycemic agents do not require frequent monitoring or injections and may therefore appeal more to patients. Further studies are needed regarding long-acting insulin and other anti-hyperglycemic agents such as thiazolidinediones, as well as identifying treatment options more specific to an individual based on risk factors and other variables predicting treatment outcomes in GDM.
authors.affiliation: Ben-Gurion University of the Negev, Soroka University Medical Center, Department of Obstetrics and Gynecology, Faculty of Health Sciences , POB 151, Beer Sheva 84101 , Israel sheiner@bgu.ac.il.
authors.forename: Jamie
authors.initials: J
authors.lastname: Klein
authors.forename: Ron
authors.initials: R
authors.lastname: Charach
authors.forename: Eyal
authors.initials: E
authors.lastname: Sheiner
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D016640:Diabetes, Gestational / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007231:Infant, Newborn; D007328:Insulin / Q000031:analogs & derivatives / Q000627:therapeutic use; D011247:Pregnancy; D015995:Prevalence
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diagnostic criteria; gestational diabetes mellitus; glyburide; insulin analogs; metformin; pharmacotherapy