Update on gestational diabetes.

As the rate of obesity increases in adolescent and adult women in the United States, practitioners of obstetrics see higher rates of gestational diabetes. Recent clinical studies suggest that women with gestational diabetes have impaired pancreatic beta-cell function and reduced beta-cell adaptation resulting in insufficient insulin secretion to maintain normal glycemia. Despite recent evidence that even mild hyperglycemia is associated with adverse pregnancy outcomes, controversies still exist in screening, management, and treatment of gestational diabetes. Initial studies regarding glyburide for treatment of gestational diabetes are promising. Overall, only about half of the women with gestational diabetes are screened in the postpartum period, an ideal time for education and intervention, to decrease incidence of glucose intolerance and progression to type 2 diabetes.