Management of gestational diabetes

Background Maternal and perinatal complications linked to gestational diabetes could be decreased with an intensive treatment Aim To assess the effect of various treatments, glycaemia targets and procedures for blood glucose self monitoring, on fetal and maternal prognosis Methods Systematic review of literature studying the efficacy of the treatment of gestational diabetes to decrease fetal morbi mortality thereof Analysis based on bibliographic search in pubmed using the following keywords therapeutic, treatment and gestational diabetes Results - Specific treatment of gestational diabetes (dietetics, physical exercise, blood glucose self monitoring, insulin therapy if appropriate) reduces severe perinatal complications (composite criterion), fetal macrosomia and pre eclampsia compared to the absence of therapy, with however an increase in the number of triggered deliveries, and without any increase in the number of cesarean sections Regarding oral antidiabetics, despite no difference was found in fetal or maternal prognosis upon treatment with glyburide, metformin, or insulin, they should not be prescribed Conclusion - The treatment of severe or moderate gestational diabetes is recommended Additional studies, in particular long term studies in children, are warranted before oral antidiabetics can be used (C) 2010 Elsevier Masson SAS All rights reserved