{"title":"[Diagnosis and treatment of gestational diabetes--the Graz model].","authors":"T Panzitt, W Zeck, K Mayer-Pickel","doi":"10.1159/000301077","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Despite the fact that gestational diabetes mellitus (GDM) is a common problem in pregnancy, a good proportion of cases of GDM is either not recognized or treated only inadequately. The main problems are a general trend of underestimating the risk of morbidity, the lack of integration into obstetric care regulations and heterogeneous guidelines regarding the screening and treatment of GDM.</p><p><strong>Methods: </strong>For decades, the Graz concept of diagnosis and therapy of GDM has offered a 1-step general screening of all pregnant women between gestational weeks 24 and 28; in addition, the option of measuring the amniotic fluid insulin concentration via amniocentesis at gestational weeks 31-32 allows to detect hyperinsulinemic fetuses who represent an obstetric high-risk group.</p><p><strong>Conclusion: </strong>Lower cutoff levels in the oral glucose challenge test as well as the measurement of amniotic fluid insulin concentrations, which have been implemented in the Graz model for a long time, offer a higher detection rate of GDM and allow a targeted therapy of fetuses at high risk. Screening and therapy of GDM are cost-effective instruments to improve obstetric outcomes, therefore obligatory screening and treatment for GDM should be recommended emphatically.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"236-43"},"PeriodicalIF":0.0000,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301077","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gynakologisch-geburtshilfliche Rundschau","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000301077","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2010/5/19 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Despite the fact that gestational diabetes mellitus (GDM) is a common problem in pregnancy, a good proportion of cases of GDM is either not recognized or treated only inadequately. The main problems are a general trend of underestimating the risk of morbidity, the lack of integration into obstetric care regulations and heterogeneous guidelines regarding the screening and treatment of GDM.
Methods: For decades, the Graz concept of diagnosis and therapy of GDM has offered a 1-step general screening of all pregnant women between gestational weeks 24 and 28; in addition, the option of measuring the amniotic fluid insulin concentration via amniocentesis at gestational weeks 31-32 allows to detect hyperinsulinemic fetuses who represent an obstetric high-risk group.
Conclusion: Lower cutoff levels in the oral glucose challenge test as well as the measurement of amniotic fluid insulin concentrations, which have been implemented in the Graz model for a long time, offer a higher detection rate of GDM and allow a targeted therapy of fetuses at high risk. Screening and therapy of GDM are cost-effective instruments to improve obstetric outcomes, therefore obligatory screening and treatment for GDM should be recommended emphatically.