What disorder is a patient with gestational diabetes mellitus (GDM) at increased risk of developing later in life?

From the Guidelines

Patients with gestational diabetes have a significantly increased risk of developing type 2 diabetes later in life, with an estimated 50-60% lifetime risk 1. The risk of developing type 2 diabetes after gestational diabetes increases linearly over a person's lifetime, with absolute risks of 20% at 10 years, 30% at 20 years, 40% at 30 years, 50% at 40 years, and 60% at 50 years 1. Some key factors that contribute to this increased risk include:

• Insulin resistance and relative insulin deficiency, which are common underlying pathophysiological mechanisms between gestational diabetes and type 2 diabetes 1
• Pre-existing insulin resistance that becomes clinically apparent under the metabolic stress of pregnancy 1
• Persistence of underlying metabolic dysfunction after delivery, despite normal blood glucose levels 1 To mitigate this risk, the following strategies are recommended:
• Regular screening for diabetes every 1-3 years, using any recommended glycemic test, such as annual A1C, annual fasting plasma glucose, or triennial 75-g OGTT 1
• Maintenance of a healthy weight, as weight loss is associated with a lower risk of developing type 2 diabetes in individuals with a history of gestational diabetes and a BMI >25 kg/m2 1
• Engagement in regular physical activity and adoption of a balanced diet low in refined carbohydrates, which can help reduce the risk of type 2 diabetes 1
• Consideration of breastfeeding, which may provide additional protective benefits against developing diabetes 1

From the Research

Increased Risk of Disorders

A patient with gestational diabetes has an increased risk of developing certain disorders later in life, including:

• Type 2 diabetes mellitus (T2DM) 2, 3, 4
• Metabolic syndrome 3, 5
• Cardiovascular morbidity 2, 3
• Malignancies 3
• Ophthalmic disease 3
• Psychiatric disease 3
• Renal disease 3

Predictive Factors

Several predictive factors have been identified for the development of type 2 diabetes in patients with a history of gestational diabetes, including:

• Use of insulin 2
• Asian origin compared to Caucasian 2
• Higher 1-h blood glucose 2
• Younger gestational age at the occurrence of gestational diabetes 4
• Higher fasting blood glucose 4
• Frequent use of insulin 4

Long-term Consequences

The long-term consequences of gestational diabetes for both the mother and offspring are significant, and may include:

• Increased risk of type 2 diabetes and metabolic syndrome 3, 5
• Adverse health outcomes for the offspring, including type 2 diabetes, obesity, and neurodevelopmental delays 3