Early testing and treatment of gestational diabetes mellitus in obese women: A systematic review of the literature
Various studies have implicated gestational diabetes mellitus (GDM) as an important environmental risk factor behind most fetal malformations, and probably, deaths. It has been reported that the incidence rate of congenital malformations in offspring of pregnant diabetic women is about three to four times more than those of infants born to non-diabetic mothers. Also, research indicates that about 7 to 10% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually in the United States. Furthermore, a plethora of scientific investigations suggest that nearly 5 to 8% of fetuses or newborn offspring of women who have been diagnosed as having gestational diabetes have a major congenital anomaly. World Health Organization (WHO) reports indicate that prevalence of GDM in the United States is expected to rise in the coming decade due to the swelling rates of overweight and obesity in recent times; this poses a major public health problem to the United States, because pregnancy outcomes of GDM-associated births are usually not good. For instance, fetal growth can be restricted in women with GDM or those who have a fasting blood glucose level of 105 mg/dl or greater. GDM is associated with increased birth injuries and health risks for the fetus such as macrosomia, shoulder dystocia, hyperbilirubinemia and hypoglycemia, respiratory distress syndrome, and childhood obesity. Maternal risks of GDM comprise pre-eclampsia or an increased risk of developing type 2 diabetes later in life. The American College of Obstetrics and Gynecology (ACOG) suggest that all women should be screened for GDM at 24 to 28 weeks gestation but does not take consider that obese women (who might also have other risk factors) stand a higher risk of getting tested too late during pregnancy. This study reviewed the literature for early testing and treatment of GDM (< 24 weeks gestation) in overweight or obese women to find out whether it can have significant improvement in maternal and perinatal outcomes, from the year 1980 to the present. Databases searched in this systematic review were: Ovid Medline (R) and PubMed (National Library of Medicine). Out of a total of 130 articles initially identified, only 1 was rated by two independent raters as being of high quality and subsequently selected for final abstraction, synthesis and evidence weighting. Results from this study suggest that, in overweight or obese women, early testing and treatment (< 24 weeks gestation) can lead to timely intervention and significant improvement in child and maternal health outcomes by preventing negative obstetric and neonatal outcomes. It is clear, therefore, from posited evidence in the literature that testing and treating GDM before the recommended 24 to 28 weeks in obese pregnant women play a significant role in reducing fetal or maternal complications. As such, to reduce perinatal complications and improve birth outcomes in overweight or obese women, the recommended gestation period for GDM testing and treatment in high risk populations need to be thoroughly addressed.
Darko, Samuel, "Early testing and treatment of gestational diabetes mellitus in obese women: A systematic review of the literature" (2013). Texas Medical Center Dissertations (via ProQuest). AAI1549850.