Glucose metabolism assessment in pregnancy

To review the literature regarding screening and definitive testing for Gestational Diabetes (GDM) and to assess whether treatment after identification changes perinatal/neonatal outcome.

Directed medline searches.

Gestational Diabetes Mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. The fetal and neonatal risks resulting from GDM continue to be controversial. There is an increased risk of macrosomia, birth trauma, and neonatal hypoglycemia but other metabolic complications are uncommon. There is still continuing debate as to whether there is an increase in congenital anomaly or stillbirth rate. Maternal risks include increased operative intervention, infections and hydramnios. Screening and definitive testing for GDM is undertaken to identify those pregnancies at risk for macrosomia, birth trauma and neonatal hypoglycemia in the hope that treatment will reduce this risk. However, at the present time there is inadequate evidence as to whether intensive management aimed at euglycemia meaningfully changes perinatal/neonatal outcome.

In spite of conflicting evidence that treatment of GDM changes pregnancy outcome, screening and definitive testing for GDM should continue until large prospective trials confirm or refute the accepted standard of care.