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RECENT ADVANCES:1.Adipose tissue inflammation is the bridge between obesity and insulin resistance, a hallmark of type 2 diabetes.Many of the immune cells implicated in obesity and type 2 diabetes are also involved in autoimmunity, suggesting that metabolic syndrome may be a form of autoimmune disease.2.Truncal obesity is powerfully associated not only with a tendency white fat inflammation and to diabetes, but also to cardiovascular disease.Interestingly, this type of obesity is seen in every hunter-gatherer (HG) population around the globe when the Western life diet style is adopted, setting a bridge between diet and immune system.3.The HAPO study, showed that there exists a continuum between maternal glycemic values and fetal weight at birth and neonatal outcome.And according to the HAPO study criteria from 10 to 15% of pregnant women are positive to GDM screening test and possibly require dietary or diet and insulin treatment.4.Treating pregnant women who have even the mildest form of gestational diabetes can reduce the risk of common birth complications among infants, as well as blood pressure disorders among mothers, and future adult diseases due to abnormal fetal programming 5.High resolution 3D sonographic imaging proved better than standard biometry in assessing fetal growth and fetal organ growth and OBJECTIVES OF TREATMENT OF GDM IN PRENGNANCY 1.Quite contrary to the common nutritional dogma of encouraging regular carbohydrates, it is suggested that pregnant women with a high waist-to-hip ratio should be strongly advised to adhere to a low-glycemic-index diet.Additionally, many dietary interventions, some of them derived from observation of HG populations, are of proven benefit in reducing the expression of glucose intolerance and may well help in tackling the obesity epidemic and not only caloric restriction.2.Fetal metabolism as assessed by fetal growth measurements is the real target of Glucose control in GDM..Maternal glycemic control is not enough to safely monitor fetal metabolic adaptation.Fetal growth as assessed by abdominal circumference and its ratio with the head circumference might not be sufficiently accurate and precise to be used as an index of fetal response to maternal glycemic control.According to our experience in two consecutive cohorts of fetuses of GDM pregnant patients is of major importance a) in tailoring GDM treatment by diet alone or diet and insulin b) in assessing fetal weight at term to guide a safe mode of delivery.