From the Guidelines
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy in women who did not have diabetes before becoming pregnant, characterized by an increased risk of large-for-gestational-age birth weight and neonatal and pregnancy complications, as well as an increased risk of long-term maternal type 2 diabetes and abnormal glucose metabolism of offspring in childhood, as noted in the 2023 study by 1.
Definition and Characteristics
GDM occurs when the body cannot produce enough insulin to meet the extra needs during pregnancy, resulting in high blood sugar levels. It typically develops in the second or third trimester and affects approximately 2-10% of pregnancies. The condition is caused by hormones produced by the placenta that interfere with the mother's insulin action, creating insulin resistance.
Risk Factors and Management
Risk factors include being overweight, having a family history of diabetes, previously giving birth to a large baby, or having had GDM in a previous pregnancy. Management typically involves blood glucose monitoring, dietary modifications, exercise, and sometimes insulin therapy if blood sugar levels cannot be controlled through lifestyle changes, as recommended by 1 and 1.
Complications and Outcomes
Untreated GDM can lead to complications for both mother and baby, including excessive birth weight, preterm birth, respiratory distress syndrome, and increased risk of cesarean delivery. According to 1 and 1, GDM also increases the risk of developing type 2 diabetes later in life, as well as cardiometabolic disorders.
Screening and Diagnosis
Screening for GDM generally occurs after 24 weeks of gestation, using methods such as the 50-g oral glucose challenge test (OGCT), as noted in 1. Early identification and treatment of GDM can help minimize the risk of adverse effects and improve pregnancy outcomes. Some key points to consider:
- GDM is a significant health concern, affecting approximately 2-10% of pregnancies, as reported by 1.
- Early screening and diagnosis are crucial to prevent complications and improve outcomes, as emphasized by 1 and 1.
- Lifestyle modifications, such as dietary changes and exercise, are essential components of GDM management, as recommended by 1 and 1.
- Insulin therapy may be necessary for some women with GDM, as noted in 1 and 1.
From the Research
Definition of Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is a condition characterized by high blood sugar levels that are first recognized during pregnancy 2, 3, 4, 5, 6.
Key Characteristics
- It poses significant risks to both maternal and fetal health 2.
- GDM can be classified as conventional gestational diabetes mellitus (cGDM) or early gestational diabetes mellitus (eGDM), depending on the time of gestation at which it is diagnosed 3.
- The condition is mainly due to increased insulin resistance of the mother, leading to a higher amount of blood glucose passing through the placenta into the fetal circulation 5.
Associated Risks
- Fetal macrosomia, defined as a birth weight ≥ 4,000 g, is a common adverse infant outcome of GDM if unrecognized and untreated in time 5.
- Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age and are more likely to develop type II diabetes later in life 5.
- GDM increases the risk of cesarean delivery, postpartum hemorrhage, and vaginal lacerations for the mother 5.
Management and Treatment
- Effective dietary interventions, such as the DASH diet and low-glycemic index diet, are critical for managing GDM 2.
- The combination of metformin and insulin aspart can effectively reduce blood glucose levels, mitigate renal injury, and improve pregnancy outcome in GDM patients 4.
- Metformin can decrease the incidence of perinatal complications and is considered a generally safe alternative to insulin 6.