Gestational diabetes.

BACKGROUND: Gestational diabetes (GD) affects 5-10% of pregnant women in Australia. Long term follow up studies show that most women with GD will progress to type 2 diabetes. The Australian Carbohydrate Intolerance in Pregnant Women study (ACHOIS) has addressed the issue of whether identifying and treating GD reduces perinatal morbidity in offspring.
OBJECTIVE: This article discusses the evidence from ACHOIS and outlines the diagnosis and management of GD. DISCUSSION: Gestational diabetes is associated with serious adverse perinatal effects. These can be reduced with diagnosis and appropriate treatment. Women at very high risk of GD should undergo diagnostic testing with a 75 g glucose tolerance test (GTT) as soon as feasible after the initial booking visit. If they do not meet the current criteria for GD, they should be re-tested at 24-28 weeks gestation. More frequent testing may be appropriate in women with multiple high risk factors. Gestational diabetes is managed initially by dietary modification, physical activity and close glucose self monitoring. Insulin therapy is commenced when glycaemic goals cannot be met on dietary adjustment alone or if there is evidence of excessive fetal growth. Women who had GD should have a GTT 2-4 months postpartum. Ongoing GTT is then needed (annually if IGT, every 2-3 years when glucose tolerance has been normal).