Gestational diabetes mellitus: Prevention, diagnosis and treatment. A fresh look to a busy corner

Article type: Review Article

Authors: Zito, G.^a | Della Corte, L.^{b; *} | Giampaolino, P.^c | Terzic, M.^{d; e; f} | Terzic, S.^d | Di Guardo, F.^g | Ricci, G.^{a; h} | Della Pietà, I.^h | Maso, G.^a | Garzon, S.ⁱ

Affiliations: [a] Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy | [b] Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy | [c] Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy | [d] Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan | [e] Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan | [f] Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA | [g] Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy | [h] Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy | [i] Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy

Correspondence: [*] Address for correspondence: Luigi Della Corte, M.D., Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, 80131 - Italy. E-mail: dellacorte.luigi25@gmail.com.

Abstract: BACKGROUND:Gestational diabetes mellitus (GDM) is a common pregnancy complication characterized by hyperglycaemia with onset or first recognition during pregnancy. Risk factors include family history of diabetes, previous GDM, genetic predisposition for GDM/type 2 diabetes, insulin resistance conditions such as overweight, obesity and ethnicity. Women with GDM are at high risk for fetal macrosomia, small for gestational age, neonatal hypoglycaemia, operative delivery and caesarean delivery. The aim of this narrative review is to summarize the most recent findings of diagnosis and treatment of GDM in order to underline the importance to promote adequate prevention of this disease, especially through lifestyle interventions such as diet and physical activity. METHODS:The research was conducted using the following electronic databases, MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrial.gov, OVID and Cochrane Library, including all published randomized and non-randomized studies as well as narrative and systematic reviews. RESULTS:The lack of universally accepted criteria makes the definition of diagnosis and prognosis of this condition difficult. Early diagnosis and glucose blood level control may improve maternal and fetal short and long-term outcomes. Treatment strategies include nutritional interventions and exercise. Medical treatment can be necessary if these strategies are not effective. Moreover, novel non-pharmacologic agents such as myo-inositol seem to be effective and safe both in the prevention and the treatment of GDM. CONCLUSIONS:It is important to promote adequate prevention of GDM. Further studies are needed in order to better define the most appropriate strategies for the clinical management of women affected by GDM.

Keywords: Gestational diabetes mellitus, risk factors, diagnosis, treatment, prevention

DOI: 10.3233/NPM-190305

Journal: Journal of Neonatal-Perinatal Medicine, vol. 13, no. 4, pp. 529-541, 2020