Short‐ and long‐term outcomes of gestational diabetes and its treatment on fetal development

Abstract

Globally the prevalence of gestational diabetes mellitus (GDM) is rising mainly due to the increase in maternal obesity. A number of different methods to screen for and diagnose GDM have been described although consensus on the preferred methods does not yet exist. GDM has significant short‐ and long‐term health risks for the mother, developing fetus and the children born to mothers with GDM. Short‐term risks for the fetus include macrosomia (excessive birthweight), shoulder dystocia, birth trauma, and hypoglycaemia in the immediate postpartum period. Long‐term risks for offspring born to mothers with GDM include increased rates of childhood and adulthood obesity and an increased cardiometabolic risk. A number of pharmacological treatments for GDM have been identified, these include insulin and oral glucose‐lowering drugs metformin and glibenclamide. Whilst these oral glucose‐lowering drugs show similar short‐term childhood outcomes to insulin there is increasing evidence that these drugs may have adverse long‐term outcomes on children and adults exposed to the drugs in utero. Future research on treatments for GDM should include long‐term follow‐ up of children exposed to glucose lowering medication in utero to determine the long‐term cardiometabolic risk in the offspring born to mothers with GDM.

Immunoendocrine Dysregulation during Gestational Diabetes Mellitus: The Central Role of the Placenta

“…Finally, fetal programming in GDM has been studied in the context of DOHaD hypothesis (developmental origins of health and disease) to understand the long-term consequences of growing in a hyperglycemic environment during life in utero. Hyperglycemia and maternal obesity generate epigenetic changes in fetal programming, increasing the risk for obesity, T2DM, impaired glucose tolerance, insulin resistance, coronary heart disease, chronic arterial hypertension, dyslipidemia, metabolic syndrome, and some cancers in the future life of the newborn [ 3 , 323 , 324 , 325 , 326 , 327 ]. Interestingly, it has been observed that GDM effects in childhood are manifested after two years of age, such as an increase in BMI and hyperglycemia [ 328 ].…”

“…Since then, diverse research papers have scrutinized these cellular cascades, and finally, in 1995, the role of PI3K and Akt in the glycemic control and other metabolic activities of insulin was described [39,40]. After IR-B binding to insulin, PI3K binds to tyrosinephosphorylated IRS proteins, leading to the formation of phosphatidylinositol (3,4,5)triphosphate (PIP3). Downstream effects of PIP3 lead to activation of 3-phosphoinositide dependent protein kinase (PDK)1 and the subsequent activation of a variety of kinases, of which Akt 1-3 is the best-studied [41].…”

“…Gestational Diabetes Mellitus (GDM) is a transient condition characterized by carbohydrate intolerance, hyperglycemia, peripheral insulin resistance, insufficient insulin secretion or activity, endothelial dysfunction, and low-grade inflammation during pregnancy, frequently between 24 and 28 weeks of gestation [ 1 ]. Although it is a transient, GDM effects can last beyond the perinatal period and impact the health of mother and fetus in both short- and long-term [ 2 , 3 , 4 ].…”

Application Value of Predictive Model Based on Maternal Coagulation Function and Glycolipid Metabolism Indicators in Early Diagnosis of Gestational Diabetes Mellitus

“…Fetal hyperinsulinemia, and macrosomia may result from inadequate blood glucose management in pregnant women with GDM ( 15 ). GDM has long-term negative impacts on children, including an increased incidence of Type 2 diabetes and obesity ( 17 ).…”

The intimate connection between maternal health and fetal development

“…The global increase in maternal obesity has also driven a rise in gestational diabetes mellitus. Murray and Reynolds review the consequences of gestational diabetes mellitus (GDM) and examine emerging concerns with use of the oral glucose‐lowering drugs, metformin, and glibenclamide 4 . Maternal preexisting diabetes can have much more profound effects on fetal development than GDM.…”