Detailed Review on Gestational Diabetes Mellitus with Emphasis on Pathophysiology, Epidemiology, Related Risk Factors, and its Subsequent Conversion to Type 2 Diabetes Mellitus

Abstract

Any degree of glucose intolerance during the pregnancy of a women is termed as Gestational Diabetes Mellitus (GDM). It may further develop into Type 2 Diabetes Mellitus (T2DM) later in life. GDM affects both mother and infant in multiple ways and there are various factors that predispose the development of GDM.The primary objective of this review is to describe the various aspects related to GDM and the subsequent risk of developing T2DM later in life.We reviewed freely accessible, full-text articles, available in PubMed, Google Scholar, and MEDLINE in the English language, till August 2022 pertaining to GDM.The pathophysiology of underlying glucose intolerance has been discussed, including the various factors like β-Cell dysfunction, chronic insulin resistance, adiponectin, insulin resistance. GDM affects pregnancies world-wide, but it is higher in the South-east Asia, northern America and Caribbean, south and central America regions. Along with ethnicity, various modifiable and non-modifiable risk factors also play a major role in development of disease. Although no standard diagnostic criteria is accepted world-wide for screening of GDM, but the one-step and two-step approach has made quite a difference. The risk of developing T2DM after GDM is well documented, and it increases with age. GDM leads to an onset of diabetes in the family at a young age, it leads to poor consequences on the health of both the mother and infant. Standard diagnostic criteria, proper education and counselling of the mother is required to tackle the condition.

Gestational diabetes – management strategies including pharmacological treatment and lifestyle interventions

“…fasting blood glucose 5.1-6.9 mmol/l (92-125 mg/dl) 2. glycemia in 1 h OGTT ≥ 10 mmol/l (180 mg/dl) 3. glycemia in 2 h OGTT 8.5-11.0 mmol/l (153-199 mg/dl) Gestational diabetes mellitus (GDM) is diagnosed when at least 1 of 3 criteria are met [42] RISK FACTORS Knowledge of GDM risk factors allows for early identification of women endangered with this disease and gives an opportunity to implement different preventive actions. [8] Obesity is one of the main risk factors due to the overproduction of pro-inflammatory cytokines by adipocytes which results in a chronic inflammatory process. This leads to metabolic imbalance and subsequently to insulin resistance and hyperglycemia in both maternal and fetal blood.…”

“…Not only high initial BMI defined as BMI ≥25 kg/m2 but also gestational BMI gain from conception to 15-20 weeks of pregnancy was correlated with an increased risk of GDM. [8] Apart from obesity other well-documented factors for GDM are maternal age (especially pregnancy after the age of 35), family history of diabetes mellitus type 2, macrosomic childbirths, stillbirths and previous birth of a child with congenital anomaly in the past medical history. [23,44].…”

“…[23,44]. Women giving birth to a macrosomic babies, when macrosomia is defined as a birth weight of 4-4,5 kg, have a higher possibility of developing GDM in the future compared to women giving birth to an infant within the range up to the 90th percentile of normal gestational weight [8]. In this study, [11] the age of pregnant individuals in the GDM group was older than that in non-GDM group, and the risk of GDM was increased by 12.5% at each increasing age of 1 year.…”

Real-World Assessment of Personalized Approach With Voglibose Fixed-Dose Combination in Type 2 Diabetes Mellitus

“…Type 2 diabetes mellitus (T2DM) is a major chronic metabolic disorder in which there is increased glucose levels in the blood and affects a huge amount of the population globally with about 1.6 million deaths every year [1][2][3]. It is the most common form of diabetes and accounts for over 90% of all diabetes mellitus cases, a condition which is characterized by diminished insulin secretion by β-cells of the pancreas, inadequate compensatory insulin secretion, and insulin resistance (IR) [4,5]. When managing T2DM, post-prandial blood glucose (PPBG) is a crucial factor that requires aggressive control as it plays a significant role in determining glycated hemoglobin (HbA1c) levels.…”

Molecular pathways and nutrigenomic review of insulin resistance development in gestational diabetes mellitus

“…Furthermore, the infant can develop shoulder dystocia, neonatal hypoglycemia, macrosomia (excessive fetal growth), jaundice, respiratory distress syndrome, and perinatal mortality ( 11–13 ). Women with GDM normally recovers after delivery, although both mother and child are more susceptible to developing obesity, hyperglycemia, vascular disorders, and type 2 Diabetes Mellitus (T2DM) in the future ( 9 , 12 , 14 , 15 ).…”