The Importance of Screening for, and managing, Gestational Diabetes Mellitus in Malta

Abstract

The detection and management of gestational diabetes mellitus (GDM) has been a source of controversy for many years. Evidence has now accumulated that dietary and insulin therapy are effective and reduce the risk of macrosomia and Caesarean section. Studies are underway to assess the impact of screening and of the different diagnostic criteria for GDM. However, studies to date have reported only an impact on obstetric, neonatal and fetal outcomes. It is now possible to prevent or at least delay the onset of maternal Type 2 diabetes, and interventions targeting women with a history of GDM are likely to have a substantive impact on the current diabetes epidemic. An even greater impact may result from preventing excessive intra-uterine exposure to hyperglycaemia, increasingly implicated as a cause of obesity and diabetes in the offspring of women with past GDM. Developing and implementing approaches to preventing long term risks to mother and baby across populations will take many years and possibly decades. In the meantime, all women should be screened for GDM so that the need for long term follow up, and, where possible, intervention for mother and baby can be identified. Such action requires knowledge of the diagnosis not only by the health care team but also the woman herself.