A Review on the Management of Gestational Diabetes Mellitus (GDM): Pharmacological and Non-Pharmacological Interventions
Download PDF
$currentUrl="http://$_SERVER[HTTP_HOST]$_SERVER[REQUEST_URI]"

Keywords

Gestational diabetes mellitus
Postprandial glucose
Macrosomia
OHA
Neonatal
Pre-eclampsia

DOI

10.26689/jcnr.v6i4.4164

Submitted : 2022-06-28
Accepted : 2022-07-13
Published : 2022-07-28

Abstract

Gestational diabetes mellitus (GDM) is defined as any degree of glucose or carbohydrate intolerance mainly during pregnancy. About 10% to 15% of pregnancies are affected and complicated by gestational diabetes. Due to hormonal changes during pregnancy, the requirement for insulin increases, and thus the usual concentration of insulin previously catered for glycemic control is ineffective. In order to meet the body’s demand, the islet cells secrete a higher amount of insulin. GDM occurs when this higher concentration is also unable to control blood glucose. This increased resistance toward insulin is most noticeable during the third trimester of pregnancy, which gradually normalizes after the termination of pregnancy. Various complications do arise, which affect both the mother and her developing fetus. In the mother, miscarriages, delivery of baby via caesarian section, and other complications may result, whereas the fetus may be affected with congenital abnormalities, neonatal hypoglycemia, and even death. Treatment of GDM includes both non-pharmacological and pharmacological interventions. Pharmacological agents are employed when non-pharmacological interventions fail to achieve the desired target. Glyburide, insulin, and metformin are the commonly used pharmacological agents. 

References

American Diabetes Association, 2004, Screening for Type 2 Diabetes. Diabetes Care, 27(Suppl 1): s11–s14.

Huri HZ, Yew HLD, Wan Ahmad WA, 2015, Association Between Glycemic Control and Antidiabetic Drugs in Type 2 Diabetes Mellitus Patients with Cardiovascular Complications. Drug Design, Development and Therapy, 9: 4735–4749.

Chirakup S, Chaiyakunapruk N, Chaikledkeaw U, et al., 2008, Cost-Effectiveness Analysis of Thiazolidinediones in Uncontrolled Type 2 Diabetic Patients Receiving Sulfonylureas and Metformin in Thailand. International Society for Pharmacoeconomics and Outcomes Research (ISPOR), 11(Suppl 1): S43–S51.

Alfadhli EM, 2015, Gestational Diabetes Mellitus. Saudi Med J, 36(4): 399–406.

Kaaja R, Ronnemaa T, 2009, Gestational Diabetes: Pathogenesis and Consequences to Mother and Offspring. The Review of Diabetic Studies, 5(4): 194–202.

Cheung NW, 2009, The Management of Gestational Diabetes. Vascular Health and Risk Management, 2009(5): 153–164.

Hebert MF, Ma X, Naraharisetti SB, et al., 2010, Are We Optimizing Gestational Diabetes Treatment with Glyburide? The Pharmacologic Basis for Better Clinical Practice. Clin Pharmacol Ther, 85(6): 607–614.

Amin MR, Hossain MZ, Miah MT, et al., 2008, Oral Antidiabetic Agents in Gestational Diabetes Mellitus – Shifting of Paradigm?. J Dhaka Med Coll, 17(2): 127–130.

Renda E, Faraci M, Di Prima FAF, et al., 2011, Treatment of Gestational Diabetes: Oral Hypoglycemic Agents or Insulin?. Journal of Prenatal Medicine, 5(3): 63–64.

Mugglestone MA, 2008, Management of Diabetes from Preconception to the Postnatal Period: Summary of NICE Guidance. BMJ, 336(7646): 714–717.

Langer O, 2007, Oral Antidiabetic Drugs in Pregnancy: The Other Alternative. Diabetes Spectrum, 20(2): 101–105.

Lawrence JM, Andrade SE, Avalos LA, et al., 2013, Prevalence, Trends, and Patterns of Use of Antidiabetic Medications Among Pregnant Women, 2001–2007. Obstet Gynecol, 121(1): 1–17.

Kavitha N, De S, Kanagasabai S, 2013, Oral Hypoglycemic Agents in Pregnancy: An Update. The Journal of Obstetrics and Gynecology of India, 63(2): 82–87.

Ho FLW, Liew CF, Cunanan EC, et al., 2007, 2007, Oral Hypoglycaemic Agents for Diabetes in Pregnancy – An Appraisal of the Current Evidence for Oral Anti-Diabetic Drug Use in Pregnancy. Annals Academy of Medicine, 36(8): 672–678.

Novak B, Pavlic-Renar I, Metelko Z, 2004, Treatment of Diabetes During Pregnancy. Diabetologia Croatica, 33(1): 3–12.

Gui J, Liu Q, Feng L, 2013, Metformin Vs Insulin in the Management of Gestational Diabetes: A Meta-Analysis. PLoS ONE, 8(5): 1–8.

American College of Obstetricians and Gynecologists, 2021, Gestational Diabetes. ACOG. https://www.acog.org/womens-health/faqs/gestational-diabetes (Accessed on January 21, 2021).

American Family Physician, 2009, Gestational Diabetes and Nutrition. Am Fam Physician, 80(1): online. https://www.aafp.org/afp/2009/0701/p57-s1.html (Accessed on January 21, 2021).

American Pregnancy Association, Glucose Tolerance Test. American Pregnancy Association. https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/glucose-tolerence-test-757/ (Accessed on January 21, 2021).

Centers for Disease Control and Prevention, Gestational Diabetes. CDC. https://www.cdc.gov/diabetes/basics/gestational.html (Accessed on January 21, 2021).

2013, Practice Bulletin No. 137: Gestational Diabetes Mellitus. Obstet Gynecol, 122(2 Pt 1): 406–416.

Butte NF, 2000, Carbohydrate and Lipid Metabolism in Pregnancy: Normal Compared with Gestational Diabetes Mellitus. Am J Clin Nutr, 71(5 Suppl): 1256S–1261S.

Wier LM, Witt E, Burgess J, et al., 2010, Hospitalizations Related to Diabetes in Pregnancy, 2008, HCUP Statistical Brief #102. Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb102.pdf (Accessed on May 1, 2014).

Hartling L, Dryden DM, Guthrie A, et al., 2012, Screening and Diagnosing Gestational Diabetes Mellitus. Evid Rep Technol Assess (Full Rep), 2012(210): 1–327.

Getahun D, Fassett MJ, Jacobsen SJ, 2010, Gestational Diabetes: Risk 0f Recurrence in Subsequent Pregnancies. Am J Obstet Gynecol, 203(5): 467.e1–467.e6.

Naylor CD, Sermer M, Chen E, et al., 1997, Selective Screening for Gestational Diabetes Mellitus. Toronto Trihospital Gestational Diabetes Project Investigators. N Engl J Med, 337(22): 1591–1596.

Kim SY, England L, Sappenfield W, et al., 2012, Racial/Ethnic Differences in the Percentage of Gestational Diabetes Mellitus Cases Attributable to Overweight and Obesity, Florida, 2004–2007. Prev Chronic Dis, 9: E88.

Solomon CG, Willett WC, Carey VJ, et al., 1997, A Prospective Study of Pregravid Determinants of Gestational Diabetes Mellitus. JAMA, 278(13): 1078–1083.

Carreno CA, Clifton RG, Hauth JC, et al., 2012, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network; Excessive Early Gestational Weight Gain and Risk of Gestational Diabetes Mellitus in Nulliparous Women. Obstet Gynecol, 119(6): 1227–1233 [Erratum in Obstet Gynecol, 120(3): 710].

Bellamy L, Casas J-P, Hingorani AD, et al., 2009, Type 2 Diabetes Mellitus After Gestational Diabetes: A Systematic Review and Meta-Analysis. Lancet, 373(9677): 1773–1779.

Balsells M, García-Patterson A, Gich I, et al., 2012, Major Congenital Malformations in Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Metab Res Rev, 28(3): 252–257.