Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24–28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.

中文翻译：

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妊娠期糖尿病的流行病学和治疗


妊娠期糖尿病被定义为在怀孕期间首次检测到的高血糖，其葡萄糖浓度低于明显糖尿病的浓度。全球约 14% 的妊娠受到妊娠期糖尿病的影响；其患病率随危险因素以及筛查和诊断方法的不同而变化；并且它与肥胖和 2 型糖尿病同时增加。仅在美国，妊娠糖尿病的直接成本就达 1·60 亿美元，主要是由于高血压、早产以及新生儿代谢和呼吸系统后果等并发症造成的。 30% 至 70% 的妊娠糖尿病是在妊娠早期诊断出来的（即妊娠 20 周前出现高血糖定义的妊娠早期糖尿病）。与诊断为晚期妊娠糖尿病（妊娠 24 周至 28 周期间的高血糖）的女性相比，早期妊娠糖尿病与更差的妊娠结局相关。随机对照试验显示，妊娠 24 周至 28 周期间治疗妊娠糖尿病具有益处。世界卫生组织 2013 年诊断妊娠期糖尿病的建议（妊娠 24-28 周时进行一步式 75 克 2 小时口服葡萄糖耐量试验）主要基于高血糖和不良妊娠结局研究，该研究证实了妊娠并发症与妊娠期糖尿病之间的线性相关性。妊娠晚期母亲血糖升高：这种现象现在也出现在妊娠早期。最近，预订妊娠糖尿病治疗（TOBOGM）试验显示，对于有危险因素的女性来说，早期妊娠糖尿病的诊断和治疗有好处。 鉴于糖尿病的流行、妊娠期糖尿病按时间和亚型异质性的证据以及技术的进步，迫切需要采用基于证据的预防、诊断和治疗策略的生命全程精准医学方法。