GESTATIONAL DIABETES MELLITUS: Challenges in diagnostics, management and impact

Abstract

Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders of pregnancy and is characterized by hyperglycemia. GDM is associated with adverse short- and long term outcomes of both mothers and their offspring. The research presented in this thesis covers the areas of diagnostics, management and impact of GDM. The main study in this thesis, the SUGAR-DIP trial, is a large, nationwide, multicenter trial, in which a new medication strategy for GDM is evaluated. In the study, a stepwise use of multiple oral glucose lowering drugs is compared to conventional insulin therapy. Oral medication has the advantage of being less invasive and thus more patient-friendly and it is expected that a combination of different oral agents is as effective as insulin. Outcomes of this trial may offer an additional, less burdensome treatment option for women with GDM. In addition to this treatment trial, we evaluate various other aspects of GDM, including the potential effect of newly proposed diagnostic criteria, novel ways to detect fetal overgrowth in diabetic pregnancies and several adverse outcomes related to GDM, such as hypertensive disorders of pregnancy, neonatal hypoglycemia and the effects of maternal diabetes on fetal cardiac development. In all these aspects of GDM, we face a continuous challenge of maintaining the balance between improving health for mothers and their offspring, and the extent of medicalization of pregnancy.