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Gestational Diabetes Mellitus

  • Glucose intolerance with onset or first recognition during pregnancy characterized by β-cell function that is unable to meet the body’s insulin needs.
  • During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5-10 years.
  • Insulin resistance begins in mid pregnancy and progresses through the third trimester, a result of maternal adiposity and effects of placental hormones. β -cells usually make more insulin to compensate for resistance – when they cannot meet the needs hyperglycemia occurs.
  • Prevalence higher
    1. in less physically active women.
    2. In older women
    3. In women with higher BMI
    4. In those with a strong family history of diabetes

Pathophysiology of Gestational Diabetes Mellitus


  • Insulin resistance increases as pregnancy progress.
  • Increased insulin resistance due to increased maternal adiposity and effects of placental hormones.
  • Hormones produced by the placenta: Human chorionic somatomammotropin (HCS), cortisol, estrogen, progesterone.
  • As pregnancy progresses and placenta grows, production of hormones increases, thus leading to increased insulin resistance.
  • GDM occurs when insulin secretion is not sufficient to offset the decrease in insulin sensitivity.

Risk Factors

    High Risk
  • Obesity
  • Diabetes in 1st degree relative
  • Previous
    1. history of GDM or glucose intolerance
    2. complicated pregnancy
    3. infant with macrosomia > 3.5 kg
  • Older Age
  • High risk ethnic group; South Asian, East Asian, Indigenous American or Australian, Hispanic
  • Polycystic Ovary Syndrome

    • Low Risk
  • Age less than 25 years
  • No previous poor pregnancy outcomes
  • No diabetes in 1st degree relatives
  • Normal prepregnancy weight and weight gain during pregnancy
  • No history of abnormal glucose tolerance
  • Short term risks for the mother
    1. Development of gestational hypertension, worsening essential hypertension or development of preeclampsia
    2. Operative delivery - related to macrosomia
    3. Polyhydramnios
    4. Premature labour
  • Long term risks for mother
    1. Development of type 2 diabetes in next ~10 years (30-60% depending on population)
    2. Development of cardiovascular disease
  • Short term risks for the baby
    1. Macrosomia
    2. Neonatal hypoglycemia
    3. Jaundice
    4. Preterm birth
    5. Birth injury
    6. Hypocalcemia/ hypomagnesimia
    7. Respiratory distress syndrome
  • Long term risks for the baby
    1. Obesity
    2. Type 2 diabetes
    Non-modifiable
  • Age > 40
  • Family history and genetic disposition
  • Ethnicity
  • History of impaired glucose tolerance and impaired fasting glucose.
  • Vascular disease
  • History of gestational diabetes or delivery of macrosomic baby.
  • polycystic ovary diseases
  • Schezoprenia
  • hypertension
  • Dyslipidaemia

    • Modifiable
  • Abdominal or central obesity
  • Over weight
  • Physical inactivity
  • Dietary factors

Signs and Symptoms

Women with gestational diabetes usually have no symptoms or mild, non-life-threatening symptoms, according to the NIH. These symptoms are mostly related to abnormal blood sugar levels, and can include fatigue, excessive thirst and increased urination.
Polyuria
Polydipsia
Polyphagia
Weight loss
Visual disturbance
Fatigue
Infections
Hunger
Sexual Problems