Читать книгу Gestational Diabetes - Группа авторов - Страница 15

In 2000, approximately 171 million people worldwide had some form of diabetes. This figure is estimated to be 361 million by 2030 [61]. It seems apparent, therefore, that rates of pregestational diabetes in pregnancy will continue to rise. A key challenge moving forward will be to identify these women before pregnancy, ensure they are well prepared for pregnancy, and receive adequate care during and after pregnancy to optimize outcomes for mother and child. While prepregnancy care programs are associated with improved pregnancy outcomes and are cost-effective, they are not available to the majority of women worldwide and uptake is poor [62, 63]. Further work is needed to develop and disseminate programs of care that are both effective and acceptable to women with established diabetes.

In regard to GDM, the future is less certain. There is a clear need for unity of approach to screening and diagnosis. However, if such a systematic approach does occur, it will have implications for health-care providers due to the associated increase in women diagnosed. Plasma glycated CD59 is showing promising potential as a screening and diagnostic test for GDM instead of the cumbersome OGTT; however, additional investigation is needed before it can be deemed suitable for use in routine clinical practice [64]. In the meantime, research continues in the area of GDM prevention. Multiple high-quality randomized controlled trials have examined the effect of antenatal lifestyle interventions in preventing GDM [65–69]. Unfortunately despite a variety of approaches including dietary modifications, exercise plans, targeting lower gestational weight gain, and motivational interviewing, overall results have been disappointing. Metformin, a medication that is known to improve insulin sensitivity, has also not been effective in preventing onset of GDM when studied in a randomized controlled trial setting [70, 71]. To date, prevention trials have not paid attention to the heterogeneity of GDM with affected women displaying differing degrees of reduced insulin secretion and increased insulin resistance [72]. Moving forward, an individualized approach to prevention of GDM may be required to achieve a significant impact on the prevalence of this condition.

In conclusion, the prevalence of both pregestational diabetes and GDM continues to rise and diabetes is likely to retain its place as the most common metabolic disorder of pregnancy well into the future.