Carreiro Marina P, Nogueira Anelise I, Ribeiro-Oliveira Antonio
Laboratory of Endocrinology, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil.
J Clin Med. 2018 Jan 25;7(2):11. doi: 10.3390/jcm7020011.
Diabetes in pregnancy, both preexisting type 1 or type 2 and gestational diabetes, is a highly prevalent condition, which has a great impact on maternal and fetal health, with short and long-term implications. Gestational Diabetes Mellitus (GDM) is a condition triggered by metabolic adaptation, which occurs during the second half of pregnancy. There is still a lot of controversy about GDM, from classification and diagnosis to treatment. Recently, there have been some advances in the field as well as recommendations from international societies, such as how to distinguish previous diabetes, even if first recognized during pregnancy, and newer diagnostic criteria, based on pregnancy outcomes, instead of maternal risk of future diabetes. These new recommendations will lead to a higher prevalence of GDM, and important issues are yet to be resolved, such as the cost-utility of this increase in diagnoses as well as the determinants for poor outcomes. The aim of this review is to discuss the advances in diagnosis and classification of GDM, as well as their implications in the field, the issue of hyperglycemia in early pregnancy and the role of hemoglobin A1c (HbA1c) during pregnancy. We have looked into the determinants of the poor outcomes predicted by the diagnosis by way of oral glucose tolerance tests, highlighting the relevance of continuous glucose monitoring tools, as well as other possible pathogenetic factors related to poor pregnancy outcomes.
孕期糖尿病，包括孕前已有的1型或2型糖尿病以及妊娠期糖尿病，是一种高度普遍的病症，对母婴健康有重大影响，具有短期和长期的后果。妊娠期糖尿病（GDM）是一种由代谢适应引发的病症，发生在妊娠后半期。关于GDM，从分类、诊断到治疗仍存在诸多争议。最近，该领域有了一些进展以及国际协会的建议，比如如何区分既往糖尿病，即使是在孕期首次确诊的，以及基于妊娠结局而非孕妇未来患糖尿病风险的新诊断标准。这些新建议将导致GDM的患病率更高，并且一些重要问题仍有待解决，比如这种诊断增加的成本效益以及不良结局的决定因素。本综述的目的是讨论GDM诊断和分类方面的进展、它们在该领域的影响、孕早期高血糖问题以及妊娠期间糖化血红蛋白（HbA1c）的作用。我们通过口服葡萄糖耐量试验研究了诊断所预测的不良结局的决定因素，强调了持续血糖监测工具的相关性，以及与不良妊娠结局相关的其他可能致病因素。
