Diabetes in pregnancy

Maternal diabetes is a significant cause of shortterm and long-term morbidity for the infant and the mother. Infants born from mothers with gestational diabetes have a high prevalence of overweight, obesity, and risk to develop type 2 diabetes later in life. Gestational diabetes affects 18% of pregnancies. Its increasing incidence and prevalence worldwide are mostly attributed to the progressively increasing rates of obesity and a changing lifestyle in the general population. Gestational diabetes is an independent risk factor for the future development of overt postpartum diabetes. Maternal and fetal complications are more frequent in patients with pre-existing diabetes than those with gestational diabetes. Nondiabetic women should receive universal screening for gestational diabetes, and women at risk for diabetes should be screened on the first prenatal visit. At present, there is general agreement on the strategy for diagnosis as well as the management of labor and delivery and postpartum follow-up in women withpre-existing diabetes and gestational diabetes. The first-line treatment for gestational diabetes consists of dietary modification and increased physical activity. Subsequent pharmacologic therapy is warranted if this strategy fails. Early diagnosis of pre-existing diabetes, as well as proper diagnosis of gestational diabetes, warrants early treatment and a strict clinical follow-up since early intervention has been shown to improve fetal and maternal outcomes in randomized controlled trials.