Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications
| Autor: | Sanjay Kalra, Om J Lakhani, Lakshmi Nagendra, Nitin Kapoor, Saptarshi Bhattacharya, Bharti Kalra, Aishwarya Krishnamurthy |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Blood Glucose
Pediatrics medicine.medical_specialty endocrine system diseases early treatment Review oral glucose tolerance test law.invention chemistry.chemical_compound Randomized controlled trial law Pregnancy Diabetes mellitus medicine Humans Multicenter Studies as Topic large-for-date baby Glycemic Glycated Hemoglobin business.industry fasting hyperglycemia Fasting Glucose Tolerance Test medicine.disease gestational diabetes mellitus Gestational diabetes Diabetes Gestational chemistry Gestation Medicine Observational study Female Glycated hemoglobin business early diagnosis |
| Zdroj: | Medical Sciences Medical Sciences, Vol 9, Iss 59, p 59 (2021) |
| ISSN: | 2076-3271 |
| Popis: | Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy. |
| Databáze: | OpenAIRE |
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