title: [Gestational diabetes mellitus].
abstract: Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity as well as long-term complications in mothers and offspring. Women detected to have diabetes early in pregnancy receive the diagnosis of overt, non-gestational, diabetes (glucose: fasting > 126 mg/dl, spontaneous > 200 mg/dl or HbA1c > 6.5 % before 20 weeks of gestation). GDM is diagnosed by an oral glucose tolerance test (OGTT) or fasting glucose concentrations (> 92 mg/dl). Screening for undiagnosed type 2 diabetes at the first prenatal visit (Evidence level B) is recommended in women at increased risk using standard diagnostic criteria (high risk: history of GDM or pre-diabetes (impaired fasting glucose or impaired glucose tolerance); malformation, stillbirth, successive abortions or birth weight > 4,500 g in previous pregnancies; obesity, metabolic syndrome, age > 45 years, vascular disease; clinical symptoms of diabetes (e. g. glucosuria)). Performance of the OGTT (120 min; 75 g glucose) may already be indicated in the first trimester in some women but is mandatory between 24 and 28 gestational weeks in all pregnant women with previous non-pathological glucose metabolism (Evidence level B). Based on the results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study GDM is defined, if fasting venous plasma glucose exceeds 92 mg/dl or 1 h 180 mg/dl or 2 h 153 mg/dl after glucose loading (OGTT; international consensus criteria). In case of one pathological value a strict metabolic control is mandatory. This diagnostic approach was recently also recommended by the WHO. All women should receive nutritional counseling and be instructed in blood glucose self-monitoring and to increase physical activity to moderate intensity levels- if not contraindicated. If blood glucose levels cannot be maintained in the normal range (fasting < 95 mg/dl and 1 h after meals < 140 mg/dl) insulin therapy should be initiated as first choice. Maternal and fetal monitoring is required in order to minimize maternal and fetal/neonatal morbidity and perinatal mortality. After delivery all women with GDM have to be reevaluated as to their glucose tolerance by a 75 g OGTT (WHO criteria) 6-12 weeks postpartum and every 2 years in case of normal glucose tolerance (Evidence level B). All women have to be instructed about their (sevenfold increased relative) risk of type 2 diabetes at follow-up and possibilities for diabetes prevention, in particular weight management and maintenance/increase of physical activity. Monitoring of the development of the offspring and recommendation of healthy lifestyle of the children and family is recommended.
authors.affiliation: Klinische Abteilung für Endokrinologie und Stoffwechsel, Gender Medicine Unit, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich. alexandra.kautzky-willer@meduniwien.ac.at.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
authors.affiliation: Klinische Abteilung für Endokrinologie und Stoffwechsel, Gender Medicine Unit, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Harreiter
authors.affiliation: Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Österreich.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Bancher-Todesca
authors.affiliation: Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.
authors.forename: Angelika
authors.initials: A
authors.lastname: Berger
authors.affiliation: Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich.
authors.forename: Andreas
authors.initials: A
authors.lastname: Repa
authors.affiliation: Abteilung für Innere Medizin, Landeskrankenhaus Hochzirl - Natters, Hochzirl, Österreich.
authors.forename: Monika
authors.initials: M
authors.lastname: Lechleitner
authors.affiliation: Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich.|Universitätsklinik für Innere Medizin I, Landeskrankenhaus Salzburg - Universitätsklinikum, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
authors.forename: Raimund
authors.initials: R
authors.lastname: Weitgasser
mesh_terms: D001317:Austria; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring / Q000592:standards; D016640:Diabetes, Gestational / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy*; D004035:Diet Therapy / Q000592:standards*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000592:standards*; D005260:Female; D005323:Fetal Monitoring / Q000592:standards; D005951:Glucose Tolerance Test / Q000592:standards; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Diabetic fetopathy; Gestational diabetes; Overweight/obesity; Pregnancy; Risk of diabetes