Published online May 15, 2015. doi: 10.4239/wjd.v6.i4.648
Peer-review started: August 28, 2014
First decision: December 17, 2014
Revised: February 4, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: May 15, 2015
Women with a history of gestational diabetes should be screened during and after the postpartum period because of a high risk for developing type 2 diabetes mellitus. Although differences exist between guidelines practiced throughout various parts of the world, all recommend the use of cutoffs for fasting and/or post-load plasma glucose to diagnose diabetes or pre-diabetes. The use of these glycemic parameters could be optimized when a trend is observed, rather than considering them as isolated values at various time points. As the presence of insulin resistance and beta-cell dysfunction start before glycemic changes are evident, the estimation of insulin sensitivity and beta-cell function by Homeostatic Model Assessment is suggested for women who have additional risk factors for diabetes, such as obesity. Disease-modifying lifestyle intervention should be the first-line strategy to prevent or delay the onset of diabetes in women with a history of gestational diabetes mellitus. Intensive lifestyle interventions are designed to decrease caloric intake and increase physical activity in order to reduce body weight and fat, which will in turn reduce insulin resistance. This article also reviews unique problems of postpartum women, which should be considered when designing and implementing an intervention. Innovative “out of the box” thinking is appreciated, as continued adherence to a program is a challenge to both the women and the health care personnel who deal with them.
Core tip: This article reviews and highlights important areas concerning diabetic risk during and after the postpartum period in women with gestational diabetes mellitus. Optimizing the use of glycemic parameters and assessing beta-cell function, particularly in high-risk women, will facilitate early recognition of those on the path to pre-diabetes and diabetes. Lifestyle interventions designed to attenuate the progression should be carefully planned, taking into consideration the unique set of problems in these women. “Out of the box” thinking is necessary to design lifestyle intervention protocols that will have high acceptance by these women.