Treatments of Gestational Diabetes Mellitus—How Can We Achieve Glycemic Targets?

Dear Colleagues,

I am pleased to invite you to read this Special Issue: “Treatments of Gestational Diabetes Mellitus—How Can We Achieve Glycemic Targets?”.

Gestational diabetes mellitus (GDM) is one of the common complications of pregnancy, and the frequency of GDM is increasing worldwide. The International Diabetes Federation’s estimates suggest that, globally, hyperglycemia in pregnancy affects about 15.8% of live births, with around 84% of these being due to gestational diabetes mellitus. GDM is defined as any glucose intolerance of variable severity with onset and first recognition occurring during pregnancy. Numerous scientific studies have shown that even mild hyperglycemia in pregnancy may adversely affect perinatal period and newborn and mother's health and is clinically important with regard to both short- and long-term maternal and fetal risks. One of the key studies on gestational diabetes was the HAPO (hyperglycemia and adverse pregnancy outcome) study results on pregnant women with mild hyperglycemia, which revealed that there was no risk threshold in the association of fetal macrosomia and glycemia. Currently, in most countries, there is a one-step diagnostic strategy. Most often, the diagnostic window is between 24 and 28 weeks of pregnancy. In addition, if a woman is at risk of hyperglycemia in pregnancy, according to most recommendations, a 75g Oral Glucose Tolerance Test (75 g OGTT) should be performed at the beginning of pregnancy. The basic element of treatment of GDM is lifestyle behavior change: nutrition therapy and physical activity during pregnancy. It should be emphasized that the diabetic diet is an element of healthy eating in pregnancy. However, in about half of women with gestational diabetes, insulin injections will be necessary to maintain glycemic targets. Metformin and glyburide should not be used as first-line agents, as both cross the placenta to the fetus.

Currently, it is still a challenge to look for a simple indicator of the risk of gestational diabetes in a healthy pregnant woman. The aim of the Special Issue is to provide an overview of the key glycemic targets for the treatment of GDM in self-monitoring with the use of a glucometer: both fasting and after a meal and time in range (TIR) when using continuous glucose monitoring (CGM). The prevention of gestational diabetes is also a key issue, especially with the use of modern technology like CGM and telemedicine. Another important aspect associated with gestational diabetes is post-partum follow up and long-term observation after GDM, especially in light of the evidence associated with an increased risk of type 2 diabetes and cardiovascular disease after GDM.

Therefore, researchers in the field of treatment of gestational diabetes are encouraged to submit their findings as original articles or reviews to this Special Issue.

Dr. Katarzyna Cyganek
Guest Editor

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