Changing trends in management of gestational diabetesmellitus
摘要
Gestational diabetes mellitus （GDM） is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control thanolder insulins. Continuous glucose monitoring systemsand continuous subcutaneous insulin systems may playa role in those who require higher doses of insulin forsugar control. Evidence exists that favors metformin asa safer alternative to insulin in view of good glycemiccontrol and better perinatal outcomes. As the risk ofdeveloping GDM in subsequent pregnancies and alsothe risk of overt diabetes in later life is high, regularassessment of these women is required in future.Lifestyle interventions or metformin should be offered towomen with a history of GDM who develop pre-diabetes.Further studies are required in the field of prevention ofGDM for optimizing obstetric outcome.