Gestational diabetes mellitus


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Abstract

Gestational diabetes mellitus (GDM) is the most common disease complicating pregnancy. GDM is associated with the development of a number of short- and long-term complications for both the mother and the fetus; therefore it is a general medical problem. Nevertheless, there is currently no consensus on the glycemic thresholds required for diagnosis and subsequent treatment. Effective treatment in women with GDM significantly reduces the risk of perinatal complications. Maintenance of normoglycemia is mainly achieved by changing the diet, increasing physical activity, and controlling weight gain during pregnancy, but some women will also need drug treatment. One of the factors determining the efficiency of non-drug therapy and the need to initiate drug treatment in women with GDM may be directly related to the pathophysiological aspects of hyperglycemia that occurs during pregnancy, namely, to which component in the pathogenesis of GDM prevails in a given woman: insulin resistance, β-cell dysfunction, or both factors are equally expressed. The heterogeneity of the pathogenetic mechanisms underlying different GDM subtypes, which is reflected in the phenotypic signs and outcomes of pregnancy, has been demonstrated in a number of studies. The results of these studies are presented in the review and are of great importance for understanding the physiology of hyperglycemia in pregnant women, suggesting that heterogeneity in the pathogenesis of GDM affects perinatal outcomes and complications associated with hyperglycemia in pregnant women, and other characteristics of pregnant women and newborns. There are presently insufficient data to revise the approach to pregnant patients with GDM, by taking into account the predominant pathogenetic component. Conclusion: Further study of the heterogeneity of GDM and its pathogenetic subtypes certainly deserves attention, since it is the predominance of a particular pathogenetic mechanism that can be a determining factor in choosing a diagnostic, therapeutic, and preventive approach.

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About the authors

Natalia I. Volkova

Rostov State Medical University Ministry of Health of Russia

MD, PhD, Professor, Vice-Сhancellor on Scientific Research, Head of the Department of Internal Diseases №3 29 Nakhichevansky Lane, Rostov-on-Don, Russia, 344022

Ilya Y. Davidenko

Rostov State Medical University Ministry of Health of Russia

MD, associate professor of the Department of Internal Medicine №3 29 Nakhichevansky Lane, Rostov-on-Don, Russia, 344022

Yuliya S. Degtyareva

Rostov State Medical University Ministry of Health of Russia

Email: i.s.degtiareva@gmail.com
postgraduate student of the Department of Internal Diseases №3 29 Nakhichevansky Lane, Rostov-on-Don, Russia, 344022

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