Authors: (Maryam Rashidi, Yazd Diabetes Research Center, Afshar Alley, Yazd, Iran)
Abstract: Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. It is defined regardless of whether insulin or only diet modification is used for treatment or the condition continues after pregnancy. GDM, the most common medical condition of pregnancy, occurs as a result of metabolic maladaptation to insulin resistance caused by hormonal changes of pregnancy. The prevalence of GDM may range from 1 to 14% of pregnancies, depending on the population studied. GDM causes a greater transfer of glucose to the fetus, causing fetal hyperinsulinemia and an overgrowth of insulin-sensitive tissues, with consequent excessive, unbalanced fetal growth, contributing more birth truama, shoulder dystocia and perinatal deaths. Also, it can cause several neonatal metabolic complications, such as hypoglycemia, hyperbilirubinemia, hypocalcemia, hypomagnesemia, polycythemia and respiratory distress syndrome. Women with GDM experience increased risk for perinatal morbidity and considerably elevated risk for diabetes and cardiovascular disorders in the years following pregnancy. Children of women with GDM are more likely to be obese and have impaired glucose tolerance and diabetes in early adulthood. Risk assessment for GDM should be done at the first prenatal visit. Women with a high risk of GDM (having obesity, family history for diabetes, personal history of GDM, or glycosuria) should be checked as soon as possible. If they do not have GDM criteria at that initial screening, they should be rechecked between 24 and 28 weeks of gestation. Women with average risk should be screened at 24–28 weeks of gestation.