ABSTRACT
Intense research effort has greatly increased the understanding of gestational diabetes mellitus (GDM), along with other forms of diabetes, in recent years. Despite this, due to the transgenerational transmission of diabetes risk associated with GDM, more effective treatments and ideally preventive measures are urgently required before GDM in pregnancy and type 2 diabetes thereafter become closer to the norm rather than just being the exception. In the UK the total cost associated with treating all types of diabetes currently stands at around £23.7 billion (approximately US$38.3 billion), and a recently published report predicts that this will rise to £39.8 billion (approximately US$64.3; around 17% of the total UK National Health Service budget based on current spending levels) by 2035-2036, as the number of people with diabetes rises from the current 3.8 million to a projected 6.25 million.1 Even the chief executive of Diabetes UK, one of the foremost diabetes charities in the UK, described the projected costs of treating all forms of diabetes by 2035 as “unsustainable.”2 Globally diabetes healthcare costs were estimated to be US$376 billion in 2010 and are predicted to be as high as US$490 billion by 2030,3 which are clearly unsupportable. As GDM increases the future of risk of developing type 2 diabetes (and even type 1 diabetes) in certain women and their offspring (reviewed in
9.1 Introduction .................................................................................................. 195 9.2 Diagnosing and Screening for Gestational Diabetes .................................... 196 9.3 Prevention of Gestational Diabetes .............................................................. 199
9.3.1 Maternal Obesity and Gestational Diabetes ..................................... 199 9.3.2 Exercise and Gestational Diabetes ................................................... 201 9.3.3 Dietary Advice and Gestational Diabetes ........................................ 201
9.4 Pathophysiology of Gestational Diabetes .....................................................204 9.5 Treatment of Gestational Diabetes ...............................................................209 9.6 What Happens after Gestational Diabetes? .................................................. 210 9.7 Key Research Questions and Conclusions .................................................... 211 References .............................................................................................................. 216
Petry4), its potential prevention through modifiable risk factors such as reductions in maternal prepregnancy weight and weight gain during pregnancy could make a big contribution toward reducing these burdensome costs in both the short and the long terms. Indeed, pregnancy may be a time when women are more amenable to altering lifestyles to more healthy ones than at other stages of their lives. Intervention studies aimed at reducing the incidence of GDM will therefore form a vital part of future GDM research.
