A Clinical Update on Gestational Diabetes Mellitus.

IF 22 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Arianne Sweeting, Jencia Wong, Helen R Murphy, Glynis P Ross
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Abstract

Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy. GDM has long been associated with obstetric and neonatal complications primarily relating to higher infant birthweight and is increasingly recognized as a risk factor for future maternal and offspring cardiometabolic disease. The prevalence of GDM continues to rise internationally due to epidemiological factors including the increase in background rates of obesity in women of reproductive age and rising maternal age and the implementation of the revised International Association of the Diabetes and Pregnancy Study Groups' criteria and diagnostic procedures for GDM. The current lack of international consensus for the diagnosis of GDM reflects its complex historical evolution and pragmatic antenatal resource considerations given GDM is now 1 of the most common complications of pregnancy. Regardless, the contemporary clinical approach to GDM should be informed not only by its short-term complications but also by its longer term prognosis. Recent data demonstrate the effect of early in utero exposure to maternal hyperglycemia, with evidence for fetal overgrowth present prior to the traditional diagnosis of GDM from 24 weeks' gestation, as well as the durable adverse impact of maternal hyperglycemia on child and adolescent metabolism. The major contribution of GDM to the global epidemic of intergenerational cardiometabolic disease highlights the importance of identifying GDM as an early risk factor for type 2 diabetes and cardiovascular disease, broadening the prevailing clinical approach to address longer term maternal and offspring complications following a diagnosis of GDM.

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妊娠糖尿病的临床最新进展。
妊娠期糖尿病(GDM)传统上是指在怀孕期间发病或首次发现的糖耐量异常。长期以来,GDM 与产科和新生儿并发症(主要与婴儿出生体重增加有关)相关联,并且越来越被认为是未来孕产妇和后代患心脏代谢疾病的风险因素。由于流行病学因素,包括育龄妇女肥胖背景率的增加和孕产妇年龄的增加,以及国际糖尿病和妊娠研究小组协会修订的 GDM 标准和诊断程序的实施,GDM 的患病率在国际上持续上升。目前,国际上对 GDM 的诊断缺乏共识,这反映了其复杂的历史演变过程,也反映了产前资源的实用性考虑,因为 GDM 已成为妊娠期最常见的并发症之一。无论如何,当代临床治疗 GDM 的方法不仅要考虑其短期并发症,还要考虑其长期预后。最近的数据显示了母体高血糖在子宫内早期暴露的影响,有证据表明,在传统诊断 GDM 之前,胎儿在妊娠 24 周就已经发育过度,而且母体高血糖对儿童和青少年的新陈代谢有持久的不利影响。GDM 对全球代际心血管代谢疾病的流行所起的重要作用,凸显了将 GDM 识别为 2 型糖尿病和心血管疾病早期风险因素的重要性,同时也拓宽了现有的临床方法,以解决 GDM 诊断后产妇和后代的长期并发症问题。
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来源期刊
Endocrine reviews
Endocrine reviews 医学-内分泌学与代谢
CiteScore
42.00
自引率
1.00%
发文量
29
期刊介绍: Endocrine Reviews, published bimonthly, features concise timely reviews updating key mechanistic and clinical concepts, alongside comprehensive, authoritative articles covering both experimental and clinical endocrinology themes. The journal considers topics informing clinical practice based on emerging and established evidence from clinical research. It also reviews advances in endocrine science stemming from studies in cell biology, immunology, pharmacology, genetics, molecular biology, neuroscience, reproductive medicine, and pediatric endocrinology.
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