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Gestational diabetes: Pathophysiology, diagnosis, treatment and new perspectives

Abstract:

Gestational diabetes mellitus (GDM) is a pathology typical in pregnancies that are usually associated with risk factors in response to multiple changes in lifestyle, worldwide increase in the prevalence of obesity, diabetes, poor eating habits and a sedentary lifestyle. This Gestational pathology is on the rise mainly in Latin America. During pregnancy different adaptive changes occur in women in order to promote an ideal environment for product development, when these mechanisms are unbalanced the woman is at risk of developing different pathologies. The glycemic metabolism produces, during the first weeks, a decrease in the fasting blood glucose and an increase in postprandial glycemia is generated due to changes in the sensitivity of insulin by the maternal tissues, so that the nutrients can be directed to the placental fetus unit. When this process is maintained through time, leptin resistance is added, and there is an increase in proinflammatory cytokines such as tumor necrosis factor alpha, interferon gamma, interleukin 2 and tumor necrosis factor β, it constitutes a proinflammatory state and main basis for the establishment of GDM. This situation has also been related to maternal-fetal complications that put at risk the life of the mother and the product such as macrosomia, premature rupture of membranes, postpartum hemorrhage, among others. In order to prevent all these conditions, a diagnostic criteria has been described, with the most accepted ones developed in this article, as well as therapeutic guidelines where the main changes are lifestyle and insulin use, however, studies have been reported where the use of metformin does not report an adverse effect for the fetus but it’s still controversial.