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Understanding and managing gestational diabetes
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- Dr. Gina Touch Mercer
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Mitochondria in reproduction and fertility: mitochondria and gametes 1
- Prof. Pascale May Panloup
- University Hospital of Angers, France
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- Prof. Robb Krumlauf
- Stowers Institute for Medical Research, USA
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, "carbohydrate intolerance 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 recommendations. 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.