From the Guidelines
Gestational diabetes is considered Type 2 Diabetes Mellitus (DMII) when blood glucose levels remain elevated after pregnancy has ended, specifically if a woman diagnosed with gestational diabetes during pregnancy still has abnormal blood glucose readings at her 4-12 week postpartum screening test. This diagnosis change is crucial because gestational diabetes is typically a temporary condition that resolves after delivery, whereas Type 2 diabetes is a chronic metabolic disorder requiring ongoing management. The underlying pathophysiology involves insulin resistance, driven primarily by pregnancy hormones in gestational diabetes 1.
Key Considerations
- Women with a history of gestational diabetes have a greatly increased risk of conversion to Type 2 diabetes over time, with studies suggesting up to 60% may develop Type 2 diabetes within 5-10 years after pregnancy 1.
- Postpartum screening, typically involving a fasting plasma glucose test, an oral glucose tolerance test, or a hemoglobin A1C test, is essential for early detection and management of Type 2 diabetes in these women.
- Lifestyle interventions and metformin have been shown to reduce progression to diabetes by 35% and 40%, respectively, over 10 years compared with placebo in women with a history of gestational diabetes and prediabetes 1.
Management and Prevention
- The adoption of a healthier diet and lifestyle modifications during the postpartum period can significantly lower the risk of developing Type 2 diabetes in women with a history of gestational diabetes 1.
- Interpregnancy or postpartum weight gain is associated with an increased risk of adverse pregnancy outcomes in subsequent pregnancies and earlier progression to Type 2 diabetes, emphasizing the importance of weight management 1.
- Both metformin and intensive lifestyle intervention can prevent or delay the progression to diabetes in women with prediabetes and a history of gestational diabetes, with only 5-6 women needing to be treated to prevent one case of diabetes over 3 years 1.
From the Research
Definition and Diagnosis of Gestational Diabetes
Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes 2. It is a serious pregnancy complication that affects approximately 14% of pregnancies globally, with its prevalence varying due to differences in risk factors and approaches to screening and diagnosis 2.
Risk of Developing Type 2 Diabetes
Women who develop gestational diabetes are at significant risk of developing Type 2 diabetes later in life 3. The risk factors for gestational diabetes include overweight and obesity, advanced maternal age, and a family history or any form of diabetes 4.
Gestational Diabetes and Diabetes Mellitus Type 2 (DMII)
Gestational diabetes is not directly called Diabetes Mellitus Type 2 (DMII), but women with gestational diabetes are at a higher risk of developing DMII later in life 4, 3. The diagnosis of gestational diabetes is based on the presence of hyperglycaemia during pregnancy, whereas DMII is a chronic condition characterized by insulin resistance and impaired insulin secretion 3, 5.
Key Points to Consider
- Gestational diabetes is a pregnancy complication that affects approximately 14% of pregnancies globally 2.
- Women with gestational diabetes are at a higher risk of developing Type 2 diabetes later in life 3.
- The diagnosis of gestational diabetes is based on the presence of hyperglycaemia during pregnancy, whereas DMII is a chronic condition characterized by insulin resistance and impaired insulin secretion 3, 5.
- Gestational diabetes is not directly called DMII, but rather a precursor or a risk factor for developing DMII later in life 4, 3.