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World J Diabetes. Dec 15, 2017; 8(12): 489-511
Published online Dec 15, 2017. doi: 10.4239/wjd.v8.i12.489
Gestational diabetes from A to Z
AbdelHameed Mirghani Dirar, John Doupis
AbdelHameed Mirghani Dirar, Prince Abdel Aziz Bin Musaad Hospital, Diabetes and Endocrinology Center, Arar 91421, North Zone Province, Saudi Arabia
John Doupis, Iatriko Paleou Falirou Medical Center, Division of Diabetes and Clinical Research Center, Athens 17562, Greece
John Doupis, Postgraduate Diabetes Education, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff CF14 4XN, United Kingdom
Author contributions: Mirghani Dirar A and Doupis J contributed equally to this work; Mirghani Dirar A and Doupis J designed the format; Mirghani Dirar A wrote the paper; Doupis J revised and approved the paper; this paper is a part of Mirghani Dirar A’s MSc Dissertation in Postgraduate Diabetes Education, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine; the MSc dissertation was supervised by Doupis J.
Conflict-of-interest statement: The authors declare that they have no conflict of interest for this paper.
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: John Doupis, MD, PhD, Director, Iatriko Paleou Falirou Medical Center, Division of Diabetes and Clinical Research Center, 36 Areos st, Paleo Faliro, Athens 17562, Greece. john.doupis@joslin.harvard.edu
Telephone: +30-210-9892300
Received: January 29, 2017
Peer-review started: February 12, 2017
First decision: May 16, 2017
Revised: October 24, 2017
Accepted: October 30, 2017
Article in press: October 31, 2017
Published online: December 15, 2017
Processing time: 311 Days and 16.9 Hours
Abstract

Gestational diabetes mellitus (GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus (T2DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent well-designed clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.

Keywords: Diabetes in pregnancy; Diagnostic criteria for gestational diabetes mellitus; Gestational diabetes mellitus-related comorbidities; Genetics of gestational diabetes mellitus; Gestational diabetes mellitus; Lipids abnormalities in gestational diabetes mellitus; Management of gestational diabetes mellitus; Medical nutrition therapy; Pathophysiology of gestational diabetes mellitus; Risk factors for gestational diabetes mellitus

Core tip: Gestational diabetes mellitus (GDM) constitutes a greater impact on the overwhelming diabetes epidemic. The recent IADPSG revised criteria are considered landmark and evidence based approach in the evolution of screening and diagnosis of GDM. However, there is, still, no consensus on its application, mainly due to concerns related to the benefit of treatment in the additionally diagnosed women and the increased cost. Herein, the authors discuss screening and diagnostic criteria, risk factors, etiology and pathophysiology of GDM along with standard management in antenatal period and during labor.