Management of gestational diabetes: pharmacologic treatment options and glycemic control.

Diabetes mellitus is one of the most common medical complications of pregnancy; gestational diabetes mellitus (GDM) accounts for approximately 90% to 95% of all cases. GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. The definition is applicable regardless of whether insulin is used to treat the disease or if the condition persists after pregnancy. It does not exclude the possibility that unrecognized glucose intolerance may have antedated the pregnancy [1]. In the United States, approximately 135,000 to 200,000 women are diagnosed annually with GDM. Approximately 9% to 12% of undiagnosed type 2 diabetes is included in the GDM population. The overall increase in obesity including women of reproductive age parallels the increase in GDM and type 2 diabetes [2]. Pregnancy is characterized by hyperinsulinemia and insulin resistance in response to the diabetogenic effects of normal carbohydrate metabolism [3]. During the first trimester and early in the second trimester, increased insulin sensitivity occurs secondary to the relatively higher levels of estrogen. In contrast, in the late second and early third trimesters, there is increased insulin resistance and reduced sensitivity to insulin action. A variety of hormonesdplacental lactogen, leptin, progesterone, prolactin, cortisol and adiponectindare instrumental in these changes. GDM and type 2 diabetes share impaired insulin secretion and insulin resistance. Insulin resistance results in decreased glucose uptake in skeletal