Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications

Abstract

Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and long-term complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM.

Keywords: Diabetes, gestational; Glucose tolerance test; Incidence; Pregnancy outcome.

Fig. 1.

Summary of two randomized controlled trials comparing the one-step and two-step approaches for the diagnosis of gestational diabetes mellitus (GDM). A one-step approach classifies more women as having GDM and requires more women to be treated for their glucose during pregnancy. The incidence of adverse pregnancy outcomes, including large for gestational age (LGA) births, did not differ between the one-step and two-step approaches. ^a[21], ^b[22].

Fig. 2.

Schematic summary of the two diagnostic approaches of gestational diabetes mellitus (GDM). DM, diabetes mellitus; LGA, large for gestational age.