Conclusions
The negative impact of the GDM on the maternal and fetal health
is well known. This impact is closely related to gestational age at which
the diagnosis of GDM is done. Therefore, the use of therapeutic options
able to prevent or delay the GDM occurrence has a positive impact on
maternal and neonatal outcomes.
Physical activity and dietary advice represent the first choice and
they are the most studied as well. They represent a non-pharmacological
option and have a positive impact on insulin resistance although they
do not seem to prevent the GDM onset. Moreover, the insufficient
compliance of the patient very often represents a limiting factor.
On the contrary, the role of hypoglycemic agent as metformin
is well known in the management and treatment of GDM. The
preconceptional use of metformin in PCOS women protects the
pancreatic beta cell reserve preventing or delaying the occurrence of
GDM. However, there are also doubts on the drug safety in pregnancy
since it completely crosses the placenta. Several authors demonstrated
the perinatal safety of the drug but larger studies are needed. From this
point of view, the inositol could represent an excellent alternative. It is
normally present in the human organism (so it could be used safely in
pregnancy) and its depletion is closely related to the insulin resistance.
Its role as insulin sensitizing agent is well documented on improving
both the hormonal and reproductive parameters. However, the
studies on its preconceptional use in preventingGDM are too limited.
The first results are extremely encouraging showing lower incidence
of GDM in the women treated with 4 g/die of MI. To confirm this
positive trend, it would be interesting to study the impact of inositol
on secondary outcomes as fetal macrosomia, gestational hypertension,
pre-eclampsia, preterm birth. In this way, we could really confirm that
the MI supplementation has a positive overall effect on the maternal
health. Furthermore, confirming these data on a larger sample size
could represent the first step in the discovery of an important and
validated non-pharmacological option to prevent GDM
ConclusionsThe negative impact of the GDM on the maternal and fetal healthis well known. This impact is closely related to gestational age at whichthe diagnosis of GDM is done. Therefore, the use of therapeutic optionsable to prevent or delay the GDM occurrence has a positive impact onmaternal and neonatal outcomes.Physical activity and dietary advice represent the first choice andthey are the most studied as well. They represent a non-pharmacologicaloption and have a positive impact on insulin resistance although theydo not seem to prevent the GDM onset. Moreover, the insufficientcompliance of the patient very often represents a limiting factor.On the contrary, the role of hypoglycemic agent as metforminis well known in the management and treatment of GDM. Thepreconceptional use of metformin in PCOS women protects thepancreatic beta cell reserve preventing or delaying the occurrence ofGDM. However, there are also doubts on the drug safety in pregnancysince it completely crosses the placenta. Several authors demonstratedthe perinatal safety of the drug but larger studies are needed. From thispoint of view, the inositol could represent an excellent alternative. It isnormally present in the human organism (so it could be used safely inpregnancy) and its depletion is closely related to the insulin resistance.Its role as insulin sensitizing agent is well documented on improvingboth the hormonal and reproductive parameters. However, thestudies on its preconceptional use in preventingGDM are too limited.The first results are extremely encouraging showing lower incidenceof GDM in the women treated with 4 g/die of MI. To confirm thispositive trend, it would be interesting to study the impact of inositolon secondary outcomes as fetal macrosomia, gestational hypertension,pre-eclampsia, preterm birth. In this way, we could really confirm thatthe MI supplementation has a positive overall effect on the maternalhealth. Furthermore, confirming these data on a larger sample sizecould represent the first step in the discovery of an important andvalidated non-pharmacological option to prevent GDM
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