Gestational Diabetes

Excerpt

Gestational diabetes mellitus (GDM) is typically defined as hyperglycemia that is diagnosed or develops during pregnancy. GDM is often divided into classes, primarily diet-controlled GDM (class A1GDM) or GDM requiring pharmacologic treatment of hyperglycemia (class A2GDM). The benefits of identifying GDM have long been established, with several studies demonstrating that women diagnosed with GDM are at high risk for developing type 2 diabetes long-term and that antepartum GDM treatment reduces adverse pregnancy outcomes. However, a consensus on the diagnostic criteria for GDM or the optimal timing for pregnancy screening has not been reached.

Over several decades, GDM management approaches have continued to evolve due to alarmingly high perinatal mortality rates among women with diabetes during pregnancy. A significant leap came in 1964 with the publication of O’Sullivan and Mahan’s landmark study that defined specific diagnostic criteria for GDM in the United States. Their criteria, based on a 100-gram 3-hour oral glucose tolerance test, were designed to identify women at increased risk, aiming to correlate maternal hyperglycemia with adverse perinatal outcomes. Subsequent validation studies underscored the importance of these thresholds in predicting both immediate complications and long-term health risks for mothers and their children.

Since then, the evolution of diagnostic criteria for GDM has reflected ongoing scientific inquiry and shifting standards in maternal-fetal medicine. From the adaptation of glucose thresholds by international bodies like the World Health Organization (WHO) to the endorsement of comprehensive criteria by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) in 2013, GDM management approaches continue to evolve. These advancements highlight not only the complexity of diagnosing GDM but also underscore the critical need for evidence-based guidelines that mitigate risks for both mothers and infants. As diagnostic strategies continue to refine, ongoing research aims to optimize maternal and perinatal outcomes while addressing the diverse healthcare needs of pregnant women globally.