Abstract

Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy (1). GDM has long been associated with obstetric and neonatal complications primarily relating to higher infant birthweight and is increasingly recognised as a risk factor for future maternal and offspring cardiometabolic disease. The prevalence of GDM continues to rise internationally due to epidemiological factors including the increase in background rates of obesity in women of reproductive age and rising maternal age, and the implementation of the revised International Association of the Diabetes and Pregnancy Study Groups’ (IADPSG) criteria and diagnostic procedures for GDM (2). The current lack of international consensus for the diagnosis of GDM reflects its complex historical evolution and pragmatic antenatal resource considerations given GDM is now one of the most common complications of pregnancy. Regardless, the contemporary clinical approach to GDM should be informed not only by its short-term complications, but by its longer term prognosis. Recent data demonstrates the effect of early in utero exposure to maternal hyperglycemia, with evidence for fetal overgrowth present prior to the traditional diagnosis of GDM from 24 weeks’ gestation, as well as the durable adverse impact of maternal hyperglycemia on child and adolescent metabolism. The major contribution of GDM to the global epidemic of intergenerational cardiometabolic disease highlights the importance of identifying GDM as an early risk factor for type 2 diabetes and cardiovascular disease, broadening the prevailing clinical approach to address longer term maternal and offspring complications following a diagnosis of GDM.

中文翻译：

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妊娠期糖尿病的临床最新进展

 抽象的

妊娠期糖尿病 (GDM) 传统上是指在怀孕期间发病或首次发现的糖耐量异常 (1)。 GDM 长期以来一直与产科和新生儿并发症相关，主要与婴儿出生体重较高有关，并且越来越多地被认为是未来孕产妇和后代心脏代谢疾病的危险因素。由于流行病学因素，包括育龄妇女肥胖背景率的增加和孕产妇年龄的增加，以及国际糖尿病和妊娠研究组协会（IADPSG）修订标准的实施，全球 GDM 的患病率持续上升GDM 的诊断程序 (2)。目前 GDM 诊断缺乏国际共识，反映出其复杂的历史演变和务实的产前资源考虑，因为 GDM 现在是最常见的妊娠并发症之一。无论如何，当代 GDM 的临床治疗方法不仅应考虑其短期并发症，还应考虑其长期预后。最近的数据表明，在子宫内早期暴露于母亲高血糖的影响，有证据表明胎儿过度生长早于妊娠 24 周的传统诊断 GDM，以及母亲高血糖对儿童和青少年代谢的持久不利影响。 GDM 对全球代际心脏代谢疾病流行的重大贡献凸显了将 GDM 确定为 2 型糖尿病和心血管疾病早期危险因素的重要性，拓宽了流行的临床方法，以解决 GDM 诊断后的长期孕产妇和后代并发症。