Abstract
Gestational Diabetes Mellitus (GDM) happens to be a very frequent and major complication of pregnancy because of higher morbidity and mortality, both for the mother and the baby. After delivery, GDM carries the risk of higher maternal morbidity due to post pregnancy obesity, development of diabetes mellitus, obesity and also cardiovascular diseases in significant number in both the mother and child for future. As per current guidelines, GDM is diagnosed at the end of the second trimester by elevated blood glucose values when, foetal damages by metabolic and epigenetic changes had already started. As a result, treatments cannot be started before the late second or third trimester, when the process of high risk of foetal morbidity and mortality has been set in. If by any method we can predict development of GDM at earliest part of first trimester or even more overjealously, we can predict, before pregnancy, then and then only we can avoid many disasters induced by GDM. With this idea many biomarkers, both clinical and laboratory based like clinical, metabolic, inflammatory and genetic markers etc., related with early pregnancy metabolic alterations have been studied for their potential to help in the prediction of later pregnancy glucose intolerance. Though promises are seen with some biomarker-enhanced risk prediction models for GDM, but lack of external validation and translation into day-to-day clinical applications, cost effectiveness, with which they may be utilized in routine prenatal care has limited their clinical use. But future is very promising and incorporating the biomarkers which precede the onset of hyperglycaemia into a risk prediction model for GDM and may help us for earlier risk assessment, screening, and diagnosis of GDM and also prevention of its both the immediate and remote complications. This review highlights the current knowledge of the understanding of the candidacy and practical utility of these biomarkers for GDM with recommendations for further research.
Highlights
Inability to adopt the changes in maternal physiology may lead to complications, such as gestational diabetes mellitus (GDM)
In most cases, the diagnosis of Gestational Diabetes Mellitus (GDM) is done around the late phase of second trimester, which may expose the foetus to the hazards of intrauterine metabolic alterations and epigenetic changes for the period of exposure
Gestational diabetes mellitus 2 (GDM2), Repeat OGCT done at 2nd trimester patients diagnosed as GDM in 2nd trimester
Summary
Norman Freinkel once told that “No single period in human development, provides a greater potential (than pregnancy) for long – range ‘pay – off ’ via a relatively short – range period of enlightened metabolic manipulation”. Inability to adopt the changes in maternal physiology may lead to complications, such as gestational diabetes mellitus (GDM). The. International Association of Diabetes and Pregnancy Study Groups (IADPSG) shows that, GDM may complicate 15–20% pregnancies, and has increased in the last 20 years in all ethnic groups as much as 27% [1]. GDM mostly develop after the 2nd trimester of pregnancy, between the 24th and the 28th week of gestation. GDM may precipitate serious and long-term complications for foetal and maternal health, in particular, metabolism and cardiovascular in nature [2]. In most cases, the diagnosis of Gestational Diabetes Mellitus (GDM) is done around the late phase of second trimester, which may expose the foetus to the hazards of intrauterine metabolic alterations and epigenetic changes for the period of exposure. The aim of this review was to find out the useful and possible markers or guides to detect GDM early in pregnancy before rise of blood sugar and if possible, even before pregnancy to avoid all complication for mother and child arising from effects of GDM on gestation
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