Gestational diabetes mellitus and possibilities for its treatment

Česká verzia

Authors: O. Krystyník; D. Goldmannová; J. Schovánek; Ľ. Cibičková; J. Spurná; D. Karásek
Authors place of work: III. interní klinika – nefrologická, revmatologická a endokrinologická LF UP a FN Olomouc
Published in the journal: Kardiol Rev Int Med 2018, 20(3): 208-211

Summary

Gestational diabetes mellitus (GDM) is a transient type of glucose intolerance of any degree that usually develops in the latter half of pregnancy. GDM has been associated with short-term adverse perinatal outcomes. Moreover, there is also an increased risk of developing type 2 diabetes mellitus in the women and their children in the long-term perspective. GDM diagnosis is based on the evaluation of the fasting plasma glucose levels as well as the postprandial plasma glucose levels following a glucose challenge during the oral glucose tolerance test. In most pregnant women with GDM, the disorder is managed effectively with dietary counselling and exercise. When the lifestyle modification fails to achieve the optimal glycaemic control, insulin injection therapy and/or metformin should be considered.

Key words:

gestational diabetes mellitus – pregnancy – therapy – insulin – metformin

Zdroje

1. Catalano PM, Roman-Drago NM, Amini SB et al. Longitudinal changes in body composition and energy balance in lean women with normal and abnormal glucose tolerance during pregnancy. Am J Obstet Gynecol 1998; 179(1): 156– 165. doi: 10.1016/ S0002-9378(98)70267-4.

2. Catalano PM, Huston L, Amini SB et al. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol 1999; 180(4): 903– 916. doi: 10.1016/ S0002-9378(99)70662-9.

3. Di Cianni G, Miccoli R, Volpe L et al. Intermediate metabolism in normal pregnancy and in gestational diabetes. Diabetes Metab Res Rev 2003; 19(4): 259– 270. doi: 10.1002/ dmrr.390.

4. Chiefari E, Arcidiacono B, Foti D et al. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest 2017; 40(9): 899– 909. doi: 10.1007/ s40618-016-0607-5.

5. Powe CE, Allard C, Battista MC et al. Heterogeneous contribution of insulin sensitivity and secretion defects to gestational diabetes mellitus. Diabetes Care 2016; 39(6): 1052– 1055. doi: 10.2337/ dc15-2672.

6. Freinkel N. Diabetic embryopathy and fuel-mediated organ teratogenesis: lessons from animal models. Horm Metab Res 1988; 20(8): 463– 475. doi: 10.1055/ s-2007-1010861.

7. Pedersen J. Diabetes and pregnancy: blood sugar of newborn infants during fasting and glucose administration. Nord Med 1952; 47(30): 1049.

8. Metzger BE, Gabbe SG, Persson B et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33(3): 676– 682. doi: 10.2337/ dc09-1848.

9. Metzger BE, Lowe LP, Dyer AR et al. HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358(19): 1991– 2002. doi: 10.1056/ NEJMoa0707943

10. Gestační diabetes mellitus. Doporučený postup screeningu, gynekologické, perinatologické, diabetologické a neonatologické péče 2017. Dostupné na: www.diab.cz/ dokumenty/ DP_GDM_2017.pdf.

11. McIntyre HD, Colagiuri S, Roglic G et al. Diagnosis of GDM: a suggested consensus. Best Pract Res Clin Obstet Gynaecol 2015; 29(2): 194– 205. doi: 10.1016/ j.bpobgyn.2014.04.022.

12. American Diabetes Association. 13. management of diabetes in pregnancy: standards of medical care in diabetes-2018. Diabetes Care 2018; 41 (Suppl 1): S137– S143. doi: 10.2337/ dc18-S013.

13. Landon MB, Spong CY, Thom E et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361(14): 1339– 1348. doi: 10.1056/ NEJMoa0902430.

14. Crowther CA, Hiller JE, Moss JR et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352(24): 2477– 2486. doi: 10.1056/ NEJMoa042973.

15. Hartling L, Dryden DM, Guthrie A et al. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. Ann Intern Med 2013; 159(2): 123– 129. doi: 10.7326/ 0003-4819-159-2-201307160-00661.

16. Hernandez TL, Van Pelt RE, Anderson MA et al. Women with gestational diabetes mellitus randomized to a higher-complex carbohydrate/ low-fat diet manifest lower adipose tissue insulin resistance, inflammation, glucose, and free fatty acids: a pilot study. Diabetes Care 2016; 39(1): 39– 42. doi: 10.2337/ dc15-0515.

17. Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care 2014; 37(12): 3345– 3355. doi: 10.2337/ dc14-1530.

18. Lapolla A, Dalfrà MG, Fedele D. Management of gestational diabetes mellitus. Diabetes Metab Syndr Obes 2009; 2: 73– 82. doi: 10.1056/ NEJM199511093331909.

19. Zawiejska A, Wender-Ozegowska E, Radzicka S et al. Maternal hyperglycemia according to IADPSG criteria as a predictor of perinatal complications in women with gestational diabetes: a retrospective observational study. J Matern Fetal Neonatal Med 2014; 27(15): 1526– 1530. doi: 10.3109/ 14767058.2013.863866.

20. Rowan JA, Hague WM, Gao W et al. The MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008; 358(19): 2003– 2015. doi: 10.1056/ NEJMoa0707193.

21. Balsells M, Garcia-Patterson A, Sola I et al. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ 2015; 350: h102. doi: 10.1136/ bmj.h102.

22. Farrar D, Simmonds M, Bryant M et al. Treatments for gestational diabetes: a systematic review and meta-analysis. BMJ Open 2017; 7(6): e015557. doi: 10.1136/ bmjopen-2016-015557.

23. Priya G, Kalra S. Metformin in the management of diabetes during pregnancy and lactation. Drugs Context 2018; 7: 1– 21. doi: 10.7573/ dic.212523.