Tamás G, Kerényi Z
National Centre for Diabetes Care, Diabetes Unit of 1st Department of Internal Medicine, Semmelweis University, Faculty of Medicine, Budapest, Hungary.
Exp Clin Endocrinol Diabetes. 2001;109 Suppl 2:S400-11. doi: 10.1055/s-2001-18598.
Gestational diabetes (GDM) is a carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy. The incidence of GDM is between 0.15-15%, which corresponds to the prevalence of type 2 diabetes and IGT in a given country.--The predominant pathogenic factor in GDM could be the inadequate insulin secretion. If GDM is not properly treated the risk of adverse maternal (preeclampsia) and fetal (large-for-gestational-age infant, macrosomia, birth trauma, cesarean section, still-birth) outcome increases. Hypertension is more prevalent in GDM, and GDM is diagnosed more frequently in women with chronic hypertension.--In order to screen for disturbances of carbohydrate metabolism during pregnancy a simple method suitable for all pregnant women would be desirable, however no such method is available at present. According to the latest WHO recommendation the screening for GDM should be performed universally with the standard 75 g oGTT evaluating only the 2-hour blood glucose values or together with the fasting ones. The latter could provide even an exact diagnosis of the carbohydrate metabolic state.--To manage GDM the first step prompt after diagnosis is to educate adequate dietary needs. If the blood sugar values in spite of an adequate diet exceed the desirable target values, insulin treatment has to be initiated.--GDM is a predictor of diabetes (mainly type 2) later in life. The cumulative incidence of type 2 diabetes is about 50% at 5 years. This review of the current literature including our own experience strongly supposes that prior GDM is also a predictor or even an early manifestation of the metabolic (insulin resistance) syndrome. By all means GDM is a cardiovascular risk factor that could be screened to prevent late complications. The previously presented evidence also strongly suggests that yearly check-ups for women with previous GDM are inevitably important.
妊娠期糖尿病（GDM）是一种碳水化合物不耐受，导致孕期出现不同严重程度的高血糖，其发病或首次被发现是在孕期。GDM的发病率在0.15%至15%之间，这与特定国家2型糖尿病和糖耐量受损的患病率相当。——GDM的主要致病因素可能是胰岛素分泌不足。如果GDM未得到妥善治疗，孕产妇不良结局（先兆子痫）和胎儿不良结局（大于胎龄儿、巨大儿、产伤、剖宫产、死产）的风险会增加。高血压在GDM中更为常见，而慢性高血压女性中GDM的诊断更为频繁。——为了筛查孕期碳水化合物代谢紊乱，需要一种适用于所有孕妇的简单方法，但目前尚无此类方法。根据世界卫生组织的最新建议，应普遍采用标准75克口服葡萄糖耐量试验（oGTT）筛查GDM，仅评估2小时血糖值或同时评估空腹血糖值。后者甚至可以提供碳水化合物代谢状态的准确诊断。——为了管理GDM，诊断后立即采取的第一步是指导适当的饮食需求。如果尽管饮食适当但血糖值仍超过理想目标值，则必须开始胰岛素治疗。——GDM是日后患糖尿病（主要是2型糖尿病）的一个预测指标。2型糖尿病的累积发病率在5年后约为50%。结合我们自己的经验对当前文献进行的综述强烈表明，既往患GDM也是代谢（胰岛素抵抗）综合征的一个预测指标甚至早期表现。无论如何，GDM是一种心血管危险因素，可以通过筛查来预防晚期并发症。之前提出的证据也强烈表明，对既往患GDM的女性进行年度检查不可避免地很重要。
