Info

Adapted from Ferrara et al. [2]. 1Adjusted for age and race-ethnicity. 2Adjusted for age.

Adapted from Ferrara et al. [2]. 1Adjusted for age and race-ethnicity. 2Adjusted for age.

standardized. Evidence for an increase in GDM was reported in Australia more than a decade ago. The data summarized in table 1 were reported from the Kaiser Permanente Health Plan of Northern California in early 2004 [2]. In this program, screening for GDM is standardized and applied universally. There is more than 85% compliance with the protocol. The data in table 1 were derived from more than 265,000 pregnancies screened for glucose intolerance. The key finding is that, during the 10-year period in which these data were collected, the overall incidence (using the criteria of Carpenter and Coustan [3] throughout) showed an increase of 41%, adjusting for the influences of maternal age and ethnic mix. In 2005, similar findings were reported in a multi-ethnic population enrolled in the Kaiser Permanente of Colorado [4] in the years 1994-2002. An Increase in GDM has also been reported in India [5]; however, detailed data on the population-wide incidence from prior and current years are lacking.

Developing an optimal strategy for dealing with the increasing prevalence of GDM presents major challenges. In addition to the failure to use the same criteria for diagnosis of GDM, there has been much controversy about the specificity of the relationships to hyperglycemia and 'the level of hyperglycemia, short of overt diabetes, that conveys increased risk' [6] and, until recently, whether treatment of GDM can improve outcomes [7]. Historically, the treatment of GDM has focused on correcting maternal hyperglycemia as a means of slowing fetal growth in an effort to avoid macrosomia and its associated morbidities, in particular risk of birth injury, cesarean delivery and neonatal morbidities. However, as will be illustrated, the pathophysiology and pathogenesis of GDM are complex and an optimal approach to treatment may involve more than simply correcting hyperglycemia. Furthermore, children who have been exposed to the intrauterine environment of diabetes or

GDM are at increased risk of obesity and altered glucose metabolism in later life [8].

Was this article helpful?

0 0
Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

Get My Free Ebook


Post a comment