Long-term Outcomes in Mothers Diagnosed With Gestational Diabetes Mellitus and Their Offspring

Abstract

Mothers with gestational diabetes mellitus (GDM) are at high lifetime risk of developing type 2 diabetes mellitus. The magnitude of risk for cardiovascular disease after GDM is less well established. Recently, intervention trials using lifestyle modification or medications used to treat type 2 DM have successfully prevented/delayed development of DM in women after GDM. Offspring of mothers with GDM are at risk for development of obesity and abnormal glucose metabolism during childhood, adolescence, and adulthood. Factors responsible for these risks are not fully understood. Having fetal hyperinsulinism is a risk factor for development of both obesity and abnormal glucose metabolism, and might be implicated in pathophysiology. It remains to be established whether the long-term effects of exposure to diabetes mellitus during intrauterine development can be prevented.

Gestational Diabetes and the Metabolic Syndrome

“…Acute maternal effects include pregnancy-induced hypertension and increased risk of Caesarian-section, while long-term consequences include increased risks of T2DM and CVD. Neonatal complications include fetal macrosomia and the associated risk of shoulder dystocia (Athukorala et al, 2007) which in turn can lead to neonatal musculoskeletal and brachial plexus injury (Christoffersson & Rydhstroem, 2002), while long-term sequelae are childhood obesity (Metzger, 2007), metabolic syndrome, and higher risk of T2DM and hypertension (Athukorala et al, 2007;Boney et al, 2005;Joffe et al, 1998;Leon, 1998;Metzger, 2007;Reece et al, 2009). Though practices vary, many countries recommend that all pregnant women be screened at 24 to 28 weeks' gestation with a 1-hour 50-g glucose challenge test (GCT), followed by a confirmatory 2-hour 75-g, or 3-hour 100-g oral glucose tolerance test (OGTT).…”

Differences in breast-feeding initiation and continuation by maternal diabetes status

“…Maternal diabetes in pregnancy may cause 'metabolic imprinting' and result in metabolic dysregulation in infants (7) , increasing the risk of the development of neonatal hypoglycaemia in early life and type 2 diabetes, obesity and metabolic syndrome later in life (8)(9)(10)(11)(12) . Diabetes in pregnancy increases the risk of premature birth, as well as increases the risk for infant morbidity and mortality (13,14) .…”

Maternal Arsenic Exposure and Impaired Glucose Tolerance during Pregnancy

“…GD is associated with 30-60% increased risk of developing diabetes in later life in the mother and also poses intergenerational risks to the fetus (Metzger 2007). Diabetes in pregnancy is associated with increased risk of major congenital malformations, macrosomia (birth weight > 4,000 g or > 90th percentile for gestational age), and complications during delivery and in the perinatal period including stillbirth (Fetita et al 2006).…”