The topic I
will cover in this presentation
is gestational diabetes.
First about my background.
I am an obstetrician with
a longstanding interest
in diabetes and pregnancy.
Till recently I was head
of the Diabetes Service
at the Royal Women's Hospital
in Melbourne, Australia.
I'm a member of the HAPO--
Hyperglycemia and Adverse Pregnancy
Outcome-- steering group with the
Secretary General of the IADPSG-
that's the International
Association of Diabetes
in Pregnancy Study Groups.
I will be making reference
during this presentation
to the findings from HAPO and
the IADPSG recommendations
on the diagnosis and classification
of hyperglycemia in pregnancy.
Issues I will covering
in this presentation
are what causes GDM, the
diagnostic criteria for GDM,
what is the evidence that treatment
improves outcomes, the treatment
options, diet, exercise, and the
place of pharmacological agents
to help achieve normal glycemia,
the timing and mode of delivery,
and then the follow up of women
who've had gestational diabetes
post-pregnancy and preparation if
they plan to become pregnant again.
Before we discuss what is thought
to cause gestational diabetes
we need to define what
we mean by the term, GDM.
Traditionally, it has
been defined as quote,
of variable severity
with onset or first recognition
in pregnancy," end quote.
This acknowledges the intolerance
may precede a pregnancy,
and we will return to this
point when we discussed
the IADPSG diagnostic
So what causes GDM?
It's been demonstrated that
women destined to develop GDM
have increased insulin resistance
and/or diminished insulin creatory
capacity before they become
pregnant, when compared with women
who do not become
hyperglycemic and develop GDM,
and these disorders of carbohydrate
metabolism persist after pregnancy.