Gestational Diabetes Mellitus

2020 ◽  
Author(s):  
Ellen W. Seely ◽  
Chloe A. Zera
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Glucose Intolerance ◽  
First Trimester ◽  
Keywords Gestational Diabetes ◽  
Obstetric Management ◽  
In Pregnancy

Gestational diabetes mellitus (GDM) has historically been defined as glucose intolerance first identified during pregnancy. The definition fails to distinguish overt (pre-gestational) diabetes diagnosed during pregnancy from glucose intolerance induced by pregnancy. Recently, the recognition that overt diabetes may first be identified in pregnancy has led to the recommendation that diabetes diagnosed in the first trimester should be termed type 2 diabetes (T2DM) rather than GDM , a clinically relevant difference in terminology as the outcomes and management of T2DM in pregnancy are distinct from outcomes and management of GDM. This chapter discusses the epidemiology, pathophysiology, screening, diagnosis, treatment and impact of GDM, as well as the obstetric management of GDM and management of GDM after pregnancy.  This review contains 8 tables, and 56 references. Keywords: Gestational diabetes mellitus, diabetes mellitus, stillbirth, glucose control, type 2 diabetes mellitus, pregnancy

scholarly journals Trans-ancestry genome-wide association study of gestational diabetes mellitus highlights genetic links with type 2 diabetes

2021 ◽  
Author(s):  
Natalia Pervjakova ◽  
Gunn-Helen Moen ◽  
Maria-Carolina Borges ◽  
Teresa Ferreira ◽  
James P Cook ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Genome Wide Association ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
Increased Risk ◽  
In Pregnancy

Gestational diabetes mellitus (GDM) is associated with increased risk of pregnancy complications and adverse perinatal outcomes. GDM often reoccurs and is associated with increased risk of subsequent diagnosis of type 2 diabetes (T2D). To improve our understanding of the aetiological factors and molecular processes driving the occurrence of GDM, including the extent to which these overlap with T2D pathophysiology, the GENetics of Diabetes In Pregnancy (GenDIP) Consortium assembled genome-wide association studies (GWAS) of diverse ancestry in a total of 5,485 women with GDM and 347,856 without GDM. Through trans-ancestry meta-analysis, we identified five loci with genome-wide significant association (p<5×10-8) with GDM, mapping to/near MTNR1B (p=4.3×10-54), TCF7L2 (p=4.0×10-16), CDKAL1 (p=1.6×10-14), CDKN2A-CDKN2B (p=4.1×10-9) and HKDC1 (p=2.9×10-8). Multiple lines of evidence pointed to genetic contributions to the shared pathophysiology of GDM and T2D: (i) four of the five GDM loci (not HKDC1) have been previously reported at genome-wide significance for T2D; (ii) significant enrichment for associations with GDM at previously reported T2D loci; (iii) strong genetic correlation between GDM and T2D; and (iv) enrichment of GDM associations mapping to genomic annotations in diabetes-relevant tissues and transcription factor binding sites. Mendelian randomisation analyses demonstrated significant causal association (5% false discovery rate) of higher body mass index on increased GDM risk. Our results provide support for the hypothesis that GDM and T2D are part of the same underlying pathology but that, as exemplified by the HKDC1 locus, there are genetic determinants of GDM that are specific to glucose regulation in pregnancy.

scholarly journals Continuing Challenges in The Medical Management of Gestational Diabetes Mellitus

EMJ Diabetes ◽  
2020 ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diabetes In Pregnancy ◽  
In Pregnancy

The management of gestational diabetes mellitus (GDM) involves screening (or universal testing), a diagnostic oral glucose tolerance test, patient counselling/education, gestational weight management and medical nutrition therapy, and self-monitoring of blood glucose levels with regular glycaemia reviews. This is in addition to pharmacological treatment, often insulin therapy, if glycaemia is above target. Females with GDM receive more frequent ultrasound testing to assess fetal growth, and birth is planned and not usually allowed to go much past term. A range of challenges continue to arise in GDM management including screening approaches and diagnostic criteria, dealing with the increasing numbers of females diagnosed, weight and glycaemic targets, the long-term safety of oral antihyperglycaemic agents for the offspring, particularly metformin, and adjunct medication for complication prevention. GDM management involves additional complexities including differentiating between those with likely undiagnosed Type 2 diabetes mellitus (diabetes in pregnancy), how to manage females with high glucose early in pregnancy less than diabetes in pregnancy, and identifying females with rare causes, for example monogenic diabetes or new Type 1 diabetes mellitus in pregnancy. While the management of GDM has evolved from identifying females at high risk of progressing to Type 2 diabetes mellitus, to greater focus on improving pregnancy outcomes, females with prior GDM and their offspring have the highest need for follow-up and prevention strategies. To date, follow-up and intervention remains limited for this high-risk group for both diabetes and cardiovascular disease. Follow-up in these females is particularly important for the next pregnancy, especially as GDM prevention from the second trimester onwards remains another continuing challenge.

scholarly journals Gestational Diabetes Mellitus: A Positive Predictor of Type 2 Diabetes?

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Gregory E. Rice ◽  
Sebastian E. Illanes ◽  
Murray D. Mitchell
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Disease Onset ◽  
First Trimester ◽  
Global Pandemic ◽  
Develop Type ◽  
Type Two Diabetes

The aim of this paper is to consider the relative benefits of screening for type two diabetes mellitus in women with a previous pregnancy complicated by gestational diabetes mellitus. Recent studies suggest that women who experience GDM are at a greater risk of developing type 2 diabetes within 10–20 years of their index pregnancy. If considered as a stand-alone indicator of the risk of developing type 2 diabetes, GDM is a poor diagnostic test. Most women do not develop GDM during pregnancy and of those that do most do not develop type 2 diabetes. There is, however, a clear need for better early detection of predisposition to disease and/or disease onset to significantly impact on this global pandemic. The putative benefits of multivariate approaches and first trimester and preconception screening to increase the sensitivity of risk assignment modalities for type 2 diabetes are proposed.

scholarly journals Elevated first trimester C-reactive protein as a predictor of gestational diabetes

2019 ◽  
Vol 6 (5) ◽  
pp. 1482
Author(s):  
Sanjay Parihar ◽  
Rajesh Singh
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
First Trimester ◽  
Antenatal Visit ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
First Trimester Of Pregnancy

Background: The incidence of type 2 diabetes is increasing at an alarming rate, particularly among young women. GDM is a unique prediabetes state that shares common risk factors with type 2 diabetes, and similar alterations in carbohydrate metabolism. Objectives of this study the elevation of C-reactive protein in the first trimester of pregnancy as a predictor of gestational diabetes.Methods: This hospital-based study comprised of patients (Primigravida) visiting the obstetric OPD or admitted in Obstetric wards. Detailed history and clinical examination of the patient was recorded on a Proforma. Blood samples of patients were taken for: (i) C-reactive protein in first trimester of pregnancy; and (ii) Blood sugar (fasting & post-prandial) during their first antenatal visit and patients were followed up in subsequent visits in second and third trimester for development of gestational diabetes.Results: There were seven women who developed gestational diabetes and had elevated first trimester C- reactive protein levels as compared to other group in which only two women developed gestational diabetes mellitus but did not have elevated C-reactive protein in their first trimester. However, there were two women, who had elevated C-reactive protein, but did not subsequently develop gestational diabetes mellitus and women with C-reactive protein in normal range who did not develop gestational diabetes mellitus were 56.Conclusion: An association between first trimester inflammation marked by increased CRP levels, and subsequent risk of development of GDM has been identified.

scholarly journals Lactation Duration and Long-term Risk for Incident Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus

Diabetes Care ◽  
2020 ◽  
Vol 43 (4) ◽  
pp. 793-798 ◽  
Author(s):  
Sylvia H. Ley ◽  
Jorge E. Chavarro ◽  
Mengying Li ◽  
Wei Bao ◽  
Stefanie N. Hinkle ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
History Of ◽  
Lactation Duration
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