Current strategy for detection and diagnosis of hyperglycemic disorders in pregnancy.

Gestational diabetes mellitus (GDM) is a metabolic alteration frequently found in pregnant women. In women with GDM, failure of pancreatic beta-cells to adapt the production of insulin at the increased metabolic demand in pregnancy, results in a inadequate insulin response, with consequent hyperglycemia. The criteria currently used for the diagnosis of GDM are too restrictive as some author suggested that different degrees of hyperglycemia, even though not diagnostic for diabetes, increase the risks of adverse perinatal outcomes (large for gestational age (LGA), higher rate of cesarean section, neonatal hypo-glycemia, respiratory distress, perinatal mortality). The objective of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was to clarify the associations of levels of maternal glucose, lower than those diagnostic of diabetes, with perinatal outcome, defining a new overall strategy recommended for detection and diagnosis of hyperglycemic disorders in pregnancy.