[Diabetes and pregnancy--a frequently underestimated problem]

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Maternal-Fetal Medicine

Background:

• Gestational diabetes mellitus (GDM) remains underdiagnosed and inadequately managed globally.
• Current global screening protocols for GDM are not universally accepted by health insurance providers.
• Carbohydrate metabolism requires careful evaluation during pregnancy, especially with identified risk factors.

Purpose of the Study:

• To emphasize the importance of investigating carbohydrate metabolism in pregnant individuals.
• To recommend diagnostic procedures for identifying GDM in high-risk pregnancies.
• To highlight specific fetal indicators that warrant further GDM investigation.

Main Methods:

• Recommending a 75-g oral glucose tolerance test (WHO standard) for pregnancies with risk factors.
• Monitoring for indicators of GDM, including fetal macrosomia, polyhydramnios, and glucosuria.
• Initiating diagnostic work-up upon detection of suggestive signs.

Main Results:

• The presence of risk factors necessitates a glucose tolerance test.
• Specific fetal indicators like macrosomia, increased amniotic fluid, or glucosuria suggest GDM.
• Fetal malformations of the heart, skeleton, or urinary tract are strong indicators for oral glucose tolerance testing.

Conclusions:

• Gestational diabetes mellitus requires greater recognition and proactive management.
• Standardized screening and diagnostic approaches, including the WHO 75-g glucose tolerance test, are vital.
• Early detection of GDM through fetal and maternal indicators improves pregnancy outcomes.