GESTATIONAL DIABETES MELLITUS: CURRENT TREATMENT STRATEGIES

Abstract

Gestational diabetes mellitus (GDM) is a metabolic condition characterized by glucose intolerance or hyperglycemia, first diagnosed during pregnancy. It is one of the most common obstetric complications, associated with adverse outcomes for both mother and fetus, and can result in macrosomia, operative delivery, shoulder dystocia, prematurity, and an increased risk of developing type 2 diabetes later in life. The prevalence of GDM has increased globally due to factors such as maternal aging, sedentary lifestyle, and rising obesity rates in women of childbearing age. The origin of the condition is associated with increased hormones that act against insulin, the physiological stress of pregnancy, and genetic and environmental factors. Placental lactogenic hormone (PDH) is identified as the main factor responsible for insulin resistance during this period. This literature review revealed that, although lifestyle modifications, such as individualized medical nutrition therapy and regular physical activity, are the first line of treatment, their effectiveness depends on patient adherence and individualized plans. These interventions achieve metabolic control in approximately 70% to 85% of diagnosed pregnant women. For refractory cases, pharmacotherapy is necessary, with insulin being the gold standard due to its safety and efficacy, as it does not cross the placenta. Although metformin is a viable alternative for certain patients, particularly those with overweight or insulin resistance, its ability to cross the placenta warrants caution. This review highlights the need for an individualized, multidisciplinary approach to the treatment of GDM, integrating pharmacological and non-pharmacological strategies with ongoing patient support to improve maternal and fetal health outcomes.