How does Gestational Diabetes affect mother and baby?

30 November 2022

There is an increased prevalence of Gestational diabetes (GDM) globally. GDM can raise the odds of complications during pregnancy as well as the future risk for both the mother and the child¹. GDM affects 3 out of 10 pregnant women, GDM affects 3 out of 10 pregnant women and this rise in cases comes alongside a dramatic increase in metabolic problems and obesity among women of childbearing age.² In Europe alone, 7.8% of pregnant women suffer from GDM. Surprisingly, the figures are even higher in South-East Asia (20.8%) and the Middle East (27.6%).³

GDM increases health risks like type 2 diabetes mellitus, cardiovascular disease, metabolic syndrome, and obesity for both the mother and the child.^1,3,4,7

Health consequences of GDM for mom and baby^1,3,5,6,7

Cesarean and operative vaginal delivery
Macrosomia
Shoulder dystocia
Neonatal hypoglycemia
Hyperbilirubinemia

An observational study conducted across several countries, including more than 23,000 women,⁴ found increased adverse pregnancy outcomes with increasing glycemia.⁴ Women who had GDM earlier are at risk of developing diabetes years after the pregnancy. Their children are also at risk of developing diabetes and obesity. Hence, it is essential to focus on gestational diabetes in pregnant women to mitigate short and long-term consequences for both the mother and the child.²

Risk factors for GDM

According to the Australasian Diabetes in Pregnancy Society guidelines, the risk factors of GDM include:

Previously elevated blood glucose level⁴
Previous hyperglycemia in pregnancy⁴
Family history of diabetes mellitus⁴
Maternal age more than 40 years⁴
Ethnicity (Asian, Middle Eastern, and African)⁴
High pre-pregnancy body mass index (BMI)⁴
Previous history of macrosomia^4,5
Polycystic ovary syndrome (PCOS)^4,5
Use of medications such as corticosteroids and antipsychotics⁴

American Diabetes Association (ADA) recommendations for screening for GDM

Pregnant women with risk factors of diabetes should be screened for type 2 diabetes mellitus at the first prenatal visit⁵
Pregnant women with no history of diabetes can be assessed for GDM at 24 to 28 weeks of gestation⁵
Pregnant women diagnosed with diabetes should be assessed for persistent diabetes at 6 to 12 weeks after childbirth⁵
Women with a history of GDM should be evaluated every three years throughout their lifetime⁵

Strategies to diagnose GDM

Considering the high prevalence of GDM, and the maternal and fetal morbidity associated with untreated or inappropriately managed GDM, the timely diagnosis of GDM will allow the initiation of appropriate treatment to prevent and minimize the ill effects Timely diagnosis prevent and minimize the ill effects of uncontrolled GDM on the mother and child of uncontrolled GDM on the mother and child in the short term and long term.¹

The oral glucose tolerance test (OGTT) is the most common glucose tolerance test, which measures the body’s response to blood glucose [6]. It is used to diagnose diabetes, gestational diabetes, and prediabetes. In this test, the plasma glucose is assessed 2 hours after ingesting 75 g of oral glucose dissolved in 300 ml of water.¹ The blood glucose assessment is done with a standardized plasma glucometer. Blood glucose levels of ≥140 mg/dL confirm the diagnosis of GDM.¹

GDM screening as per the American and Canadian guidelines:

Pregnant women are screened with a 50g/hour plasma glucose test (>140 mg/dL value observed as positive)¹
Women who are confirmed positive in the 1st step are given a 100gm oral glucose tolerance test (OGTT) in the 2nd step¹
GDM is diagnosed if two or more abnormal plasma glucose values are observed in this test¹

GDM screening as per the National Institute for Health and Care Excellence (NICE) and Australian guidelines:

Recommends a risk-based screening using OGTT (75gm in 2hr)¹
The test cut-offs were fasting plasma glucose level ≥126mg/dL and post 2hr ≥140mg/dL¹
The WHO supports screening for GDM universally at 24-28 weeks of gestation (75gm in 2hr)¹

Conclusion

Gestational diabetes can raise the odds of pregnancy complications. Diagnosis of GDM may help devise management strategies to improve maternal and fetal outcomes.⁴

References