Abstract
Gestational diabetes mellitus (GDM) is the commonest medical complication of pregnancy. The association of GDM with immediate pregnancy complications including excess fetal growth and adiposity with subsequent risk of birth trauma and with hypertensive disorders of pregnancy is well recognized. However, the associations with wide ranges of longer-term health outcomes for mother and baby, including the lifetime risks of obesity, pre-diabetes, and diabetes and cardiovascular disease have received less attention and few health systems address these important issues in a systematic way. This article reviews historical and recent data regarding prediction of GDM using demographic, clinical, and biochemical parameters. We evaluate current and potential future diagnostic approaches designed to most effectively identify GDM and extend this analysis into a critical evaluation of lifestyle and nutritional/pharmacologic interventions designed to prevent the development of GDM. The general approach to management of GDM during pregnancy is then discussed and the major final focus of the article revolves around the importance of a GDM diagnosis as a future marker of the risk of non-communicable disease (NCD), in particular pre-diabetes, diabetes, and cardiovascular disease, both in mother and offspring.
Highlights
Both Hyperglycemia in Pregnancy (HIP) and obesity among women of childbearing age are increasing to epidemic proportions [1, 2]
We are following the diagnostic framework for HIP as recommended by the International Federation of Gynecology and Obstetrics (FIGO) [3] which considers any degree of glucose elevation in pregnancy as part of the umbrella definition of HIP
This broad group is further divided into those women with either known pre-pregnancy diabetes or markedly elevated glucose levels which would qualify for a diagnosis of diabetes outside pregnancy
Summary
Both Hyperglycemia in Pregnancy (HIP) and obesity among women of childbearing age are increasing to epidemic proportions [1, 2]. We are following the diagnostic framework for HIP as recommended by the International Federation of Gynecology and Obstetrics (FIGO) [3] which considers any degree of glucose elevation in pregnancy as part of the umbrella definition of HIP This broad group is further divided into those women with either known pre-pregnancy diabetes or markedly elevated glucose levels which would qualify for a diagnosis of diabetes outside pregnancy. Pre-eclampsia was more frequent in the “obesity/non GDM group”, while excess fetal growth and fetal hyperinsulinemia were slightly more common in the “GDM/no obesity group” than in the “obesity/non GDM group” The combination of both factors was accompanied by an additive increase in pregnancy complications. While not ignoring obesity as a major health problem, our current review will focus primarily on the prediction and diagnosis of GDM and outline optimal management both during and following pregnancy
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