Review: Gestational Diabetes Mellitus and Its Management

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy.  Insulin deficiency in turn leads to chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism. As with diabetes mellitus in pregnancy in general, babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. There are 2 subtypes of gestational diabetes. One is Type A1 gestational diabetes where abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting and 2 hours after meals; diet modification is sufficient to control glucose levels) and other is Type A2 gestational diabetes where abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required. The goal of treatment is to reduce the risks of GDM for mother and child. A repeat OGTT should be carried out 2–4 months after delivery, to confirm the diabetes has disappeared. Afterwards, regular screening for type 2 diabetes is advised. If a diabetic diet or G.I. Diet, exercise, and oral medication are inadequate to control glucose levels, insulin therapy may become necessary. Glyburide and Metformin, a second generation sulfonylurea, has been shown to be an effective alternative to insulin therapy. In one study, 4% of women needed supplemental insulin to reach blood sugar targets. Key words: Gestational diabetes mellitus, etiology, Management, oral hypoglycemic agents.