Gestational Diabetes: A Review

Gestational diabetes (GD) is a disorder of glucose tolerance resulting in hyperglycemia first diagnosed during pregnancy. Its worldwide prevalence is estimated at 14% but varies regionally. In 2008, new diagnostic criteria were adopted, leading to an increase in diagnosed cases. Biomarkers could potentially serve as an alternative to the current diagnostic criteria in the future, enabling the realization of a universally applicable GD screening program. Risk factors associated with GD encompass a range of factors, including epigenetic factors, inadequate vitamin D levels, family history of diabetes, prediabetes, obesity, fetal death, polycystic ovary syndrome (PCOS), and advanced maternal age. GD can have consequences for maternal health, increasing the risk of hypertensive disorders, premature labor, cesarean delivery, metabolic disorders, and later type 2 diabetes. In children, it may be associated with macrosomia, shoulder dystocia, respiratory insufficiency, and hospitalization in the neonatal intensive care. Offspring born to mothers with GD face heightened susceptibility to childhood and adult obesity, alongside elevated cardiometabolic risk. The consequences and risk factors of GD are not fully understood to this day. Therefore, Additional research is warranted to gain a deeper comprehension of the pathophysiology underlying the disease and to ascertain efficacious preventive and therapeutic approaches. Nutritional therapy is often sufficient to achieve normoglycemia objectives. An individualized nutritional program is recommended, providing the necessary nutrients to promote maternal and infant health, attain optimal gestational weight gain and uphold glycemic regulation. However, in some cases, additional antidiabetic therapy is necessary. Insulin remains the most commonly used treatment, but metformin may be a safe and effective alternative. This still needs to be validated by in-depth studies leading to better evaluation of its long-term effects on offspring.