Gestational diabetes: diagnostic approaches, risks, and prediabetic state during pregnancy

Different levels of glucose tolerance disorders that occur for the first time or that are detected during pregnancy are known as gestational diabetes mellitus (GDM). Although GDM is also detected in women with carbohydrate-related disorder (type 1 and type 2 diabetes) before pregnancy, the dominant group is patients with hyperglycemia that develops during pregnancy. It is worth noting that pregnancy diabetes is a disease that not only disrupts the course of pregnancy but also adversely affects the future of mothers and offspring [3].

According to the current recommendations, all pregnant women should be diagnosed with glucose tolerance disorders. The initial fasting glycaemic labelling should be carried out immediately at the beginning of pregnancy, on the first visit to the gynecologist, and the glycaemia level should not exceed 92 mg/dl (table 1). Women at risk are advised to immediately undergo a diagnostic test called the commonly used oral glucose load test (75 g OGTT), which is generally carried out between 24 and 28 weeks of pregnancy.

The fetus developing in the womb is very sensitive to too high or too low levels of glucose in the mother's womb, and therefore the metabolic balancing of diabetes guarantees a reduction in the risk of maternal and perinatal death of the newborn by as much as half [1]. The consequences of carbohydrate disorders during pregnancy are particularly dangerous because they pose a risk to both the mother and the developing fetus. The effects of elevated sugar levels in the body of the mother also depend not only on the complications of intrauterine and peripheral glucose, but also on the first week of pregnancy. Hyperglycemia in the early stages of pregnancy is also a risk factor for early development of the fetus, especially in the later stages.

However, it should be emphasized that elevated fasting glucose levels in the first trimester of pregnancy do not allow for a clear diagnosis, as this requires confirmation by a 75 g OGTT diagnostic test. In the case of pre-diabetic diabetes, appropriate therapeutic procedures should be implemented to monitor the maintenance of normal glycaemic values as well as the prevention of complications of pregnancy and newborns.