Prevention of gestational diabetes mellitus. Minireview
Gestational Diabetes Mellitus (GDM) is associated with adverse maternal, fetal and neonatal outcomes and is increasing worldwide probably for the increasing rate of overweight and obesity, being the latter a major risk factor. To these women with well recognized risk factors some interventions to prevent GDM should be offered. In this way, possible interventions are diet and/or exercise, metformin and myo-inositol. Diet and exercise are considered first line for the prevention of GDM, but in particular kind of pregnant women like obese, who usually follow unhealthy life styles, this type of intervention may fail. Metformin is usually used for the treatment of Diabetes Mellitus type 2 and recently also for hyperinsulinemic infertile women affected by polycystic ovary syndrome with the aim to restore ovarian cycle and ovulation. In these women, metformin was given off-label throughout pregnancy, but in prospective, randomized trials, especially when obese women are involved, metformin failed to prevent GDM. On the other hand, a supplement, myo-inositol demonstrated to reduce GDM rate when it was given since first trimester. This review analyses the effect of these three interventions for preventing GDM with the help of the most recent literature.