[Management of gestational diabetes]

Abstract

Background: Maternal and perinatal complications linked to gestational diabetes could be decreased with an intensive treatment.

Aim: To assess the effect of various treatments, glycaemia targets and procedures for blood glucose self-monitoring, on fetal and maternal prognosis.

Methods: Systematic review of literature studying the efficacy of the treatment of gestational diabetes to decrease fetal morbi-mortality thereof. Analysis based on bibliographic search in pubmed using the following keywords: "therapeutic", "treatment" and "gestational diabetes".

Results: Specific treatment of gestational diabetes (dietetics, physical exercise, blood glucose self-monitoring, insulin-therapy if appropriate) reduces severe perinatal complications (composite criterion), fetal macrosomia and pre-eclampsia compared to the absence of therapy, with however an increase in the number of triggered deliveries, and without any increase in the number of cesarean sections. Regarding oral antidiabetics, despite no difference was found in fetal or maternal prognosis upon treatment with glyburide, metformin, or insulin, they should not be prescribed.

Conclusion: The treatment of "severe or moderate" gestational diabetes is recommended. Additional studies, in particular long-term studies in children, are warranted before oral antidiabetics can be used.