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Feature Article

Gestational diabetes: modern approaches to diagnosis and management

Aidan McElduff

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Abstract

Most women in Australia are screened during pregnancy for gestational diabetes. However, how this is performed is currently under active review. If the new criteria from the International Association of Diabetes and Pregnancy Study Groups are adopted in Australia, it will increase the number of women diagnosed with gestational diabetes significantly and will therefore have major workload implications.

Key Points

  • Gestational diabetes is common and the prevalence is increasing, almost certainly related to the increase in maternal obesity.
  • Gestational diabetes is associated with adverse pregnancy outcomes for both mother and baby, which can be reduced by appropriate management of gestational diabetes (level 1 evidence).
  • Management of gestational diabetes usually involves education, advice about diet and exercise, and insulin therapy if the home monitored blood glucose levels are above target. The evidence base for any specific dietary therapy is not strong.
  • Women with a history of gestational diabetes are at increased risk of developing type 2 diabetes. This risk can be reduced by appropriate diet, exercise and pharmacological interventions (level 1 evidence).
  • Women with a history of gestational diabetes are at increased risk of cardiovascular disease. This risk and the risk of developing type 2 diabetes need to be appropriately monitored.

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