Current and Future Trends in Gestational Diabetes Diagnosis, Care and Neonatal Outcomes

Gestational diabetes mellitus (GDM) is defined in the World Health Organization guidelines as glucose intolerance or hyperglycemia that occurs or is first recognized during pregnancy. Changes in lifestyle and increasing maternal age have led to a markedly increased prevalence (from 1-26% according to different studies) in the past two decades. Suboptimal GDM management can lead to maternal and neonatal adverse outcomes (short and long term). Maternal complications include preeclampsia, cesarean section, and polyhydramnios in the short term, and the progression of diabetes mellitus after pregnancy in the long term. Fetal and neonatal complications include congenital malformation, neonatal death, stillbirth, macrosomia, obstetric trauma, shoulder dystocia, and neonatal hypoglycemia. Optimal glucose control is the mainstay of preventing hyperinsulinemia and macrosomia. Insulin is the current conventional treatment. However, dose titration is often difficult (risk of glucose variability and hypo-/hyperglycemia) and require frequent monitoring. During the last 20 years, oral hypoglycemic agents (OHAs) have been introduced, mainly glyburide and metformin. Although there is an increasing amount of evidence that supports the use of glyburide or metformin for GDM, the American Diabetes Association (ADA) and American College of Obstetricians and Gynecologists (ACOG) still recommend insulin as the primary medical treatment if the glycaemic treatment goals are not achieved with life-style intervention, due to the lack of evidence regarding the long-term safety of the alternatives. Although reports have described successful use of insulin pumps in patients with GDM, their use in the context is still sporadic as there are no clear data to suggest that they are necessary or more effective than conventional therapy, and the cost (depending on reimbursement policies) of an insulin pump may not be justified over the relatively short duration of a pregnancy.

The aim of this research topic is to focus on current state-of-the-art studies and future perspectives encompassing GDM pathogenesis, natural history, management and discussion on maternal and neonatal outcomes and future therapeutic interventions.

Specific themes of interest:

• Disease and complications pathogenesis and modelling

• Natural history and follow-up of mothers and newborns

• Current and future treatment and prevention perspectives, for any of the clinical features