Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark

Abstract

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of varying severity and is present in about 2-6% of all pregnancies in Europe, making it one of the most common pregnancy disorders. Aside from the short-term maternal, fetal and neonatal consequences associated with GDM, there are long-term consequences for both mother and child. Although maternal glucose tolerance often normalises shortly after pregnancy, women with GDM have a substantially increased risk of developing type 2 diabetes later in life. Studies have reported that women are more than seven times as likely to develop diabetes after GDM, and that approximately 50% of mothers with GDM will develop diabetes within 10 years, making GDM one of the strongest predictors of type 2 diabetes. In women with previous GDM, development of type 2 diabetes can be prevented or delayed by lifestyle intervention and/or medical treatment. Systematic follow-up programmes would be ideal to prevent progression of GDM to diabetes, but such programmes are unfortunately lacking in the routine clinical set-up in most countries. Studies have found that the risks of obesity, the metabolic syndrome, type 2 diabetes and impaired insulin sensitivity and secretion in offspring of mothers with GDM are two- to eightfold those in offspring of mothers without GDM. The underlying pathogenic mechanisms behind the abnormal metabolic risk profile in offspring are unknown, but epigenetic changes induced by exposure to maternal hyperglycaemia during fetal life are implicated. Animal studies indicate that treatment can prevent long-term metabolic complications in offspring, but this remains to be confirmed in humans. Thus, diabetes begets diabetes and it is likely that GDM plays a significant role in the global diabetes epidemic. This review summarises a presentation given at the 'Gestational diabetes: what's up?' symposium at the 2015 annual meeting of the EASD. It is accompanied by two other reviews on topics from this symposium (by Marja Vääräsmäki, DOI: 10.1007/s00125-016-3976-6 , and by Cuilin Zhang and colleagues, DOI: 10.1007/s00125-016-3979-3 ) and an overview by the Session Chair, Kerstin Berntorp (DOI: 10.1007/s00125-016-3975-7 ).

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

“…Mothers who experience preeclampsia are at increased risk of renal disease, CVD, and ESKD in later life [58,62]. Mothers experiencing GDM are at increased risk of developing overt diabetes over time (Table 11) [372,445]. Although these long-term risks are well recognized, uptake of subsequent maternal screening is poor, even when offered free of charge [445].…”

“…Mothers experiencing GDM are at increased risk of developing overt diabetes over time (Table 11) [372,445]. Although these long-term risks are well recognized, uptake of subsequent maternal screening is poor, even when offered free of charge [445]. New mothers must be educated about the need for follow-up immediately postpartum and at follow-up visits for the child, and health care workers must be aware of the risk and need for follow-up.…”

Gestational diabetes: what’s up?

“…Marja Vääräsmäki provides an update on whether GDM is worth treating [25], Cuilin Zhang et al, discuss whether prevention of GDM is possible [26], and Peter Damm et al review the long-term consequences of GDM [27].…”

MECHANISMS IN ENDOCRINOLOGY: Epigenetic modifications and gestational diabetes: a systematic review of published literature

“…Offspring of mothers with GDM have an increased risk of birth complications associated with increased birth weight and adiposity, such as shoulder dystocia, neonatal hypoglycemia and obesity, as well as for developing metabolic syndrome, type 2 diabetes (T2DM) and cardiovascular disease in adult life (1,2). Furthermore, in a 5-to 10-year perspective, it is estimated that around 50% of the women diagnosed with GDM will develop T2DM, although the subsequent T2DM risk varies greatly with criteria used and follow-up time (3,4). As GDM and T2DM appear to share both genetic and non-genetic risk factors, the overlapping susceptibility may partly explain the increased risk of T2DM for women with previous GDM (5,6).…”