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World J Diabetes. Mar 15, 2015; 6(2): 284-295
Published online Mar 15, 2015. doi: 10.4239/wjd.v6.i2.284
Changing trends in management of gestational diabetes mellitus
Gunasekaran Kala Poomalar
Gunasekaran Kala Poomalar, Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College Hospital, Madagadipet, Puducherry 605107, India
Author contributions: Poomalar GK designed the research study and solely contributed to this paper.
Conflict-of-interest: The author reports no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gunasekaran Kala Poomalar, DGO, DNB (OG), Associate Professor, Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College Hospital, Kesavan Road, Madagadipet, Puducherry 605107, India. poomalarpragash@gmail.com
Telephone: +91-413-2205239
Received: August 21, 2014
Peer-review started: August 22, 2014
First decision: September 16, 2014
Revised: October 18, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: March 15, 2015
Processing time: 209 Days and 20.3 Hours
Abstract

Gestational diabetes mellitus (GDM) is on the rise globally. In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it, there is a splurge of research in this field and management of GDM is undergoing a sea change. Trends are changing in prevention, screening, diagnosis, treatment and future follow up. There is emerging evidence regarding use of moderate exercise, probiotics and vitamin D in the prevention of GDM. Regarding treatment, newer insulin analogs like aspart, lispro and detemir are associated with better glycemic control than older insulins. Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control. Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes. As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high, regular assessment of these women is required in future. Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome.

Keywords: Gestational diabetes mellitus; Prevention; Vitamin D; Probiotic; Insulin analogs; Oral hypoglycemic agents

Core tip: To summarize, the use of probiotics and vitamin D supplementation may help in preventing gestational diabetes mellitus (GDM) in high risk women. Glycemic targets need to be lower than current recommendations. Oral hypoglycemic agents are an effective and safe alternative to insulin in managing GDM. Newer insulins, aspart, lispro and detemir, provide better glycemic control than routinely used insulin. Continuous glucose monitoring systems and insulin pumps may be of use in women who require a very high dose of insulin. Lifestyle interventions in GDM women help to reduce the subsequent development of diabetes. Further studies are required in the field of prevention of GDM for optimizing obstetric outcome.