Pregnancy support- Pathology

Gestational Diabetes updated: 03 November 2008

Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied. No specific cause has been identified, but it is believed that the hormones produced during pregnancy reduce a woman's sensitivity to insulin, resulting in high blood sugar levels.

Consequences of fetal exposure to maternal diabetes in offspring

J Clin Endocrinol Metab. 2006 Oct;91(10):3718-24. Epub 2006 Jul 18

Fetita LS, Sobngwi E, Serradas P, Calvo F, Gautier JF.

CONTEXT: Type 2 diabetes is the result of both genetic and environmental factors. Fetal exposure to maternal diabetes is associated with a higher risk of abnormal glucose homeostasis in offspring beyond that attributable to genetic factors, and therefore, may participate in the excess of maternal transmission of type 2 diabetes. Evidence acquisition: A MEDLINE search covered the period from 1960-2005. EVIDENCE SYNTHESIS: Human studies performed in children and adolescents suggest that offspring who had been exposed to maternal diabetes during fetal life exhibit higher prevalence of impaired glucose tolerance and markers of insulin resistance. Recent studies that directly measured insulin sensitivity and insulin secretion have shown an insulin secretory defect even in the absence of impaired glucose tolerance in adult offspring. In animal models, exposure to a hyperglycemic intrauterine environment also led to the impairment of glucose tolerance in the adult offspring. These metabolic abnormalities were transmitted to the next generations, suggesting that in utero exposure to maternal diabetes has an epigenetic impact. At the cellular level, some findings suggest an impaired pancreatic beta-cell mass and function. Several mechanisms such as defects in pancreatic angiogenesis and innervation, or modification of parental imprinting, may be implicated, acting either independently or in combination. CONCLUSION: Thus, fetal exposure to maternal diabetes may contribute to the worldwide diabetes epidemic. Public health interventions targeting high-risk populations should focus on long-term follow-up of subjects who have been exposed in utero to a diabetic environment and on a better glycemic control during pregnancy.

Publication Types:

• Review

Gestational diabetes after delivery. Short-term management and long-term risks

Diabetes Care. 2007 Jul;30 Suppl 2:S225-35

Kitzmiller JL, Dang-Kilduff L, Taslimi MM.

After the intensified treatment often required for treating gestational diabetes mellitus (GDM), clinicians may be tempted to relax after delivery of the baby. If it is assumed that no further management is needed, an excellent opportunity to improve the future health status of these high-risk women may be lost. There are special concerns for the early postpartum care of women with GDM. Encouragement and facilitation of exclusive breastfeeding is very important because of the profound short-term as well as long-term health benefits to the infant and the reduced risks for subsequent obesity and glucose intolerance demonstrated in many breastfeeding women. A method of contraception should be chosen that does not increase the risk of glucose intolerance in the mother. Some women with GDM will have persisting hyperglycemia in the days after delivery that will justify medical management for diabetes and perhaps for hypertension, microalbuminuria, and dyslipidemia. Treatment should be maintained according to the guidelines of the American Diabetes Association and other relevant organizations and adjusted for the needs of lactation. Treatment should be continued in adequate fashion to minimize risks to the early conceptus if there is a subsequent planned or unplanned pregnancy.

Publication Types:

• Review

Low birth weight as a risk factor for gestational diabetes, diabetes, and impaired glucose tolerance during pregnancy

Diabetes Care. 2007 Jul;30 Suppl 2:S147-9

Pettitt DJ, Jovanovic L.

Small size at birth as a risk factor for the development of diabetes or other metabolic disorders has been described in numerous populations over the past 2 decades (1–12). Most studies dealing with children or nonpregnant adults have reported an inverse linear relationship between birth size and the prevalence of disease (1–4,6–10), but the relationship among the Pima Indians from Arizona has been described as "U-shaped" because the high risk is seen in individuals with high birth weight as well as low birth weight (5). Several reasons for this relationship have been proposed (13) and a similar finding was subsequently reported among schoolchildren in Taiwan (11). Since the 4th International Workshop-Conference on Gestational Diabetes Mellitus, where the association between a woman's birth weight and gestational diabetes mellitus (GDM) or pregestational diabetes was first presented (14), there have been several similar reports in the literature. The purpose of this article is to review some of the recently published data on this relationship, which is well described in the general population but still less studied among pregnant women.

Publication Types:

• Review

Gestational diabetes mellitus

J Clin Invest. 2005 Mar;115(3):485-91

Buchanan TA, Xiang AH.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy. GDM is detected through the screening of pregnant women for clinical risk factors and, among at-risk women, testing for abnormal glucose tolerance that is usually, but not invariably, mild and asymptomatic. GDM appears to result from the same broad spectrum of physiological and genetic abnormalities that characterize diabetes outside of pregnancy. Indeed, women with GDM are at high risk for having or developing diabetes when they are not pregnant. Thus, GDM provides a unique opportunity to study the early pathogenesis of diabetes and to develop interventions to prevent the disease

Publication Types:

• Review

Vitamin and mineral deficiencies which may predispose to glucose intolerance of pregnancy

J Am Coll Nutr. 1996 Feb;15(1):14-20

Jovanovic-Peterson L, Peterson CM.

There is an increased requirement for nutrients in normal pregnancy, not only due to increased demand, but also increased loss. There is also an increased insulin-resistant state during pregnancy mediated by the placental anti-insulin hormones estrogen, progesterone, human somatomammotropin; the pituitary hormone prolactin; and the adrenal hormone, cortisol. If the maternal pancreas cannot increase production of insulin of sustain normoglycemia despite these anti-insulin hormones, gestational diabetes occurs. Gestational diabetes is associated with excessive nutrient losses due to glycosuria. Specific nutrient deficiencies of chromium, magnesium, potassium and pyridoxine may potentiate the tendency towards hyperglycemia in gestational diabetic women because each of these four deficiencies causes impairment of pancreatic insulin production. This review describes the pathophysiology of the hyperglycemia and the nutrient loss in gestational diabetes and further postulates the mechanism whereby vitamin/mineral supplementation may be useful to prevent or ameliorate pregnancy-related glucose intolerance.

Publication Types:

• Review

Publication Types:

• Review