Gestational Diabetes Mellitus

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Gestational Diabetes Mellitus (GDM) is diabetes or impaired glucose tolerance of variable severity with the first recognition during pregnancy. Screening is now part of routine antenatal care in many settings in developed countries. There are several screening tests, but the most common is the oral glucose tolerance test, which tests the blood glucose level in order to initiate treatment for the prevention of complications in pregnant women and their infants. There is substantial debate surrounding the most suitable screening tests, the effectiveness of treatment in averting adverse mother and infant outcomes in women with mild to moderate glucose intolerance, the possibility of causing anxiety, and the potentially adverse effects of a “high risk” label in pregnancy for those with Gestational Diabetes Mellitus. A systematic review of the literature was conducted in order to examine the psychosocial effects of screening for Gestational Diabetes Mellitus. There was inconsistency in the results due to the variety of designs and methods used, and the outcomes assessed.

Most studies found no significant differences between women with Gestational Diabetes Mellitus and controls regarding mental health (anxiety and depression), concerns for the health of the newborn, and attitudes towards screening for Gestational Diabetes Mellitus. However, women who were found to have Gestational Diabetes Mellitus or who had false-positive results were more likely to worry about their own health than those whose screening test was negative or were not tested. Women with Gestational Diabetes Mellitus were more likely than controls to rate their health as poor rather than excellent. The long term consequences of these concerns are not known. Many studies were methodologically weak, with low recruitment rates, large losses to follow up, recall bias, turf effects, and the use of unstandardised measures. More studies in this field are needed since there is little research investigating the psychosocial implications of screening for GDM.

Gestational diabetes mellitus (GDM) is controversial in terms of management and outcomes among women who are initially found to have glucose intolerance during pregnancy (Khandelwal, 1999; Scott, 2002). There is debate regarding appropriate screening and diagnostic criteria for elevated blood glucose during pregnancy, the best screening methods to be applied (Rumbold and Crowther, 2001; Scott, 2002), and also regarding the benefits and potential harm of screening programs (Brody, 2003). However, screening for GDM is becoming part of routine antenatal care in many parts of the world. An important aspect of the evaluation of any screening program is its impact on those who are screened (Rumbold and Crowther, 2001).

GDM is identification of diabetes, or impaired glucose tolerance (IGT) of variable severity first recognized during pregnancy (American Diabetes Association, 2004). GDM exists when there is an increase in blood glucose levels (Scott, 2002) because of a disorder of carbohydrate metabolism (Metzger and Coustan, 1998). This disorder may affect the fetus and newborn as well as the mother if untreated (Jones and Stone, 1998).

GDM is associated with a disorder of insulin resistance, insulin action and insulin secretion during pregnancy. Thus, GDM is classified as Type-2 diabetes. Some women with GDM go on to develop Type-2 diabetes in later life (Daniells, 2003; Khandelwal, 1999).