Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California, 2250 Alcazar Street, CSC 205, Los Angeles, CA 90033, USA.
Nat Rev Endocrinol. 2012 Nov;8(11):639-49. doi: 10.1038/nrendo.2012.96. Epub 2012 Jul 3.
Gestational diabetes mellitus (GDM) carries a small but potentially important risk of adverse perinatal outcomes and a long-term risk of obesity and glucose intolerance in offspring. Mothers with GDM have an excess of hypertensive disorders during pregnancy and a high risk of developing diabetes mellitus thereafter. Diagnosing and treating GDM can reduce perinatal complications, but only a small fraction of pregnancies benefit. Nutritional management is the cornerstone of treatment; insulin, glyburide and metformin can be used to intensify treatment. Fetal measurements complement maternal glucose monitoring in the identification of pregnancies that require such intensification. Glucose testing shortly after delivery can stratify the short-term diabetes risk in mothers. Thereafter, annual glucose and HbA(1c) testing can detect deteriorating glycaemic control, a harbinger of future diabetes mellitus, usually type 2 diabetes mellitus. Interventions that mitigate obesity or its metabolic effects are most potent in preventing or delaying diabetes mellitus. Lifestyle modification is the primary approach; use of medications for diabetes prevention after GDM remains controversial. Family planning enables optimization of health in subsequent pregnancies. Breastfeeding may reduce obesity in children and is recommended. Families should be encouraged to help children adopt lifestyles that reduce the risk of obesity.
妊娠期糖尿病（GDM）会增加围产期不良结局的风险，并使后代长期面临肥胖和葡萄糖耐量受损的风险，虽然风险较小，但却很重要。患有 GDM 的母亲在怀孕期间会出现高血压疾病增多的情况，并且此后发生糖尿病的风险很高。诊断和治疗 GDM 可以减少围产期并发症，但只有一小部分妊娠受益。营养管理是治疗的基石；胰岛素、格列美脲和二甲双胍可用于强化治疗。胎儿测量结果可补充母体葡萄糖监测，以确定需要强化治疗的妊娠。分娩后不久进行的葡萄糖检测可以对母亲的短期糖尿病风险进行分层。此后，每年进行血糖和 HbA1c 检测可以检测到血糖控制恶化的情况，这是未来发生糖尿病（通常为 2 型糖尿病）的先兆。减轻肥胖或其代谢影响的干预措施在预防或延迟糖尿病方面最为有效。生活方式改变是主要方法；GDM 后用于预防糖尿病的药物使用仍存在争议。计划生育可以优化后续妊娠的健康状况。母乳喂养可能会降低儿童肥胖的风险，因此建议母乳喂养。应鼓励家庭帮助儿童养成降低肥胖风险的生活方式。
