Gestational diabetes mellitus: comprehensive management from screening to postpartum follow-up

Overview

Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy that arises from a combination of insulin resistance and an inadequate compensatory response of pancreatic beta cells. In addition to the immediate risk of perinatal complications, GDM is a significant marker for the future development of type 2 diabetes and cardiometabolic diseases in the mother, as well as for potentially adverse metabolic programming of the offspring. In Slovakia, the diagnosis of GDM is guided by Standard Diagnostic and Therapeutic Procedures and is based on a one-step approach using a 75-gram oral glucose tolerance test, with the diagnosis established upon a single abnormal result. Treatment is based on an individualized approach that includes lifestyle modifications, regular blood glucose monitoring, and pharmacotherapy if necessary. In most patients, adequate control can be achieved through non-pharmacological measures; however, if these fail, insulin remains the first-line treatment. Metformin represents an alternative in selected patients; however, its use requires individual consideration due to transplacental transfer and limited long-term data. An important part of management is also the postpartum period, as women with a history of GDM have a significantly increased risk of developing type 2 diabetes. Therefore, systematic postpartum follow-up and lifestyle intervention are essential to reduce long-term metabolic risk.

Keywords:

metformin – screening – gestational diabetes mellitus – type 2 diabetes mellitus – continuous glucose monitoring – insulin – metformin – oral glucose tolerance test (oGTT) – gestational hyperglycemia