Читать книгу Gestational Diabetes - Группа авторов - Страница 60

Prior to the suggested IADPSG guidelines, it was per definition that any carbohydrate intolerance discovered during pregnancy is GDM [48]. However, this is not truly the case, as women may have overt diabetes, simply not tested or not diagnosed prior to pregnancy [49]. Moreover, others may have GDM diagnosed early in pregnancy, not preexisting prior to pregnancy. The possibility to diagnose overt diabetes during pregnancy is important since it has practical implications on prenatal care and postpartum management. The importance of recognizing these women involves higher prevalence of major congenital malformations, possibility of diabetic nephropathy and retinopathy during pregnancy, and continued treatment of diabetes after delivery [50–52].

The novel approach presented in the IADPSG strategy allows diagnosis of early GDM and overt diabetes, at early pregnancy. However, these recommendations have few drawbacks: (1) guidelines for early diagnosis of overt diabetes and GDM are supported mainly by expert opinion; (2) it has not been determined whether universal or selective testing should be done, and the IADPSG has left it to be decided by local preferences; (3) there is no recommendation as of the timing of such testing and is vaguely defined to be done “during the first prenatal visit”; and (4) no data support treatment of early GDM for improved pregnancy outcome.