Endocrine Abstracts

Some 50 years on from the originally published description of gestational diabetes mellitus, debates continues as to the significance of minor degrees of glucose intolerance for maternal/fetal outcome. Confusion has been compounded by different diagnostic practices and the likelihood that there is a continuum of risk. A fundamental lack of robust evidence is reflected in the lack of consensus among published guidelines. The picture has been further complicated by the current sophistication of obstetric and neonatal intensive care, the potential for confounding by established risk factors and by traditional obstetric practice. Until recently, the therapeutic options have largely rested on a combination of diet and exercise with our without the addition of insulin. Evolution of the therapeutic armamentarium to include insulin analogues and oral hypoglycaemic agents has presented new challenges both in terms of efficacy and safety. Against this background, the evidence for screening and diagnosis of hyperglycaemia in pregnancy will be reviewed and treatment strategies discussed. Ongoing clinical trials will be highlighted.