[Gestational diabetes: new approaches to an old and growing problem].

Gestational diabetes is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. Gestational Diabetes generally disappears as soon as the pregnancy is terminated. The prevalence of gestational diabetes is 2% to 13%, depending on the genetic characteristics and environment of the population under study. Classic risk factors identify a population of women at risk of gestational diabetes (obesity, family history of diabetes, or previous poor obstetric history); however, these risk factors identify only 60% of women diagnosed as having gestational diabetes. Therefore, it is necessary to screen all pregnant women, regardless of history, for gestational diabetes. The optimal time to screen for gestational diabetes in pregnancy is between 24 and 28 weeks of gestation. The screening test consist of 50 g of oral glucose followed by a plasma determination at 1 hour. If the plasma glucose 1 hour after the oral load is > or = 140 mg/dl, a glucose tolerance test is indicated. The goal of management (diet, insulin and exercise) of the gestational diabetic women is to maintain normoglycemia, needed to avoid complications for the fetus and mother.