Perspectives in gestational diabetes mellitus: A review of screening, diagnosis, and treatment

GDM is associated with a myriad of fetal and maternal complications. Identifying women with GDM through screening at appropriate gestational age given their risk is crucial to avoiding unfavorable outcomes. It is important for providers to explore the possibility of unmasked type 2 diabetes or even type 1 diabetes caught in the prodromal phase in women with GDM, especially if overt hyperglycemia is present early in pregnancy. Several agents that are both efficacious and safe are being used to treat women with GDM if diet and exercise fail; these include human insulin, insulin analogs, and glyburide. Studies are underway to test the safety and efficacy of metformin in pregnancy. Women with GDM need to be followed postpartum and monitored for type 2 diabetes to reduce the risks for complications of diabetes and to avoid conception of future pregnancies in the setting of uncontrolled hyperglycemia.