Gestational Diabetes: Risk or Myth?

Abstract

As currently defined (5), gestational diabetes is associated with important perinatal and long-term health risks. Many of the risks increase, in relation to the severity of maternal hyperglycemia. For perinatal risks to infants, the relationship seems to be continuous. Maternal fasting glucose levels can be used to identify subsets of patients with very low and very high risks. The majority of pregnancies lie between these two extremes; and nonglucose measures, such as fetal ultrasound, can be used to enhance risk assessment, thereby minimizing over- and undertreatment of patients. The major long-term maternal risk is development of type 1 or type 2 diabetes, predominantly the latter. The risk increases continuously, in relation to maternal glycemia during and, especially, after pregnancy. Patients seem to have a B-cell defect that is characterized by maladaptation to insulin resistance. The B-cell defect is predictive of future diabetes, supporting the testing and clinical application of interventions that minimize insulin resistance to delay or prevent diabetes. Women with impaired glucose tolerance in the first few months postpartum are at particularly high risk for diabetes and should receive the most intensive education, intervention, and follow-up. Offspring of women with GDM are at increased risk for obesity and have an unexpectedly high prevalence of elevated glucose levels during childhood and adolescence. Both genetic and intrauterine environmental influences are likely to contribute to these abnormalities. Optimal strategies to detect and prevent the long-term risks to offspring remain to be established.

First-Trimester C-Reactive Protein and Subsequent Gestational Diabetes

“…This estimate will likely increase in the future, given the alarming increase in rates of obesity and type 2 diabetes among young women in the U.S. (2). Like type 2 diabetes, GDM results from a combination of increased insulin resistance and impaired pancreatic insulin secretion (3,4), and women with a history of GDM are at significantly increased risk of developing type 2 diabetes in the future (5).…”

Congenital Cardiopathies Screening Associated with Diabetes Mellitus Using Maternal Fructosamine Plasma Concentration

“…Experimental studies suggest that hyperglycemia is the major teratogen in diabetic pregnancies, but other diabetes-related factors may also affect fetal outcomes (Aberg at al., 2001;Buchanan & Kjos, 1999;Leonard et al, 1989;Ren et al, 2011). It is a fact that an uncontrolled diabetes mellitus in early gestation is associated with a teratogenic effect, causing primary cardiogenesis defects.…”

“…Hypertrophic cardiomyopathy observed in the infant of the diabetic mother is characterized by thickening of the interventricular septum, and to a lesser extent the ventricular free walls (Hornberger, 2006). The presence of this pathology whether is associated with fetal hyperinsulinaemia and general somatic growth in maternal diabetes (Buchanan & Kjos, 1999;Ren et al, 2011). But, the wide variety of cardiac abnormalities suggests a complex pathogenesis.…”

Use of Insulin Pumps in Pregnancies Complicated by Type 2 Diabetes and Gestational Diabetes in a Multiethnic Community

“…is associated with important perinatal and long-term health risks for both mother and child (1). Type 2 diabetes in pregnancy is associated with an increased risk of operative delivery, and the risk of perinatal mortality may even be higher than that in type 1 diabetes (2).…”