Maternal outcomes and follow‐up after gestational diabetes mellitus

Abstract

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease.

Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study

“…[7], in which 13.7% had a BMI ≥ 33 kg/m 2 at inclusion. However, obesity is still far less than reported in recent US reports, which ranged from 20.0% [28] to 31.9% [29]. Indeed, as in the US [15], our study shows that race/ethnicity is a determinant of overweight/obesity.…”

“…Our present study found that the effects of BMI and GWG were greatest in patients without GDM, who received no specific care in our maternity unit at the time. This has been consistently reported in women without GDM [5,15,16,28]. For example, Di Benedetto et al [8] showed, in an Italian cohort, that the effect of overweight and obesity was present only in glucose-tolerant women who had excess weight gain during pregnancy.…”

“…When only women with GDM were considered, GWG, but neither overweight nor obesity, were associated with macrosomia [9]. However, an independent effect of GWG and obesity on LGA infants was found in three American studies [16,28,29]. This was also the case of the study by Black et al [5] although, in that study, GDM was treated by neither diet nor medication.…”

Lifestyle interventions to reduce risk of diabetes among women with prior gestational diabetes mellitus

“…Compared with women with healthy pregnancies, women with histories of GDM have elevated CVD risk factors including higher blood pressure, triglyceride levels, and lower HDL [8]. Consistent with these findings, a meta-analysis found that GDM confers a 7-fold risk for future type 2 diabetes [9] and up to one third of women with type 2 diabetes have previously been diagnosed with GDM [10].…”

Gestational diabetes

“…Women with higher BMIs and/or higher intra-partum or post-partum weight gain are most at risk of type 2 diabetes, every 1-kg increase in pre-pregnancy weight being associated with a 40% increase in risk. 27 The Diabetes Prevention Program (DPP) suggested that metformin and lifestyle intervention are equally effective in reducing risk of progression to type 2 diabetes by around 50%. 28 C Treatment reduces the risk of serious perinatal complications in women with severe hyperglycaemia in pregnancy (fasting plasma glucose (FPG) <7.8 mmol/litre) C Treatment has beneficial effects on maternal weight gain, infant birth weight, caesarean delivery, pre-eclampsia, pregnancyinduced hypertension and neonatal adiposity, in women with both mild (FPG <5.3 mmol/litre) and more moderate (FPG <7.8 mmol/litre) hyperglycaemia in pregnancy C The level of glycaemic control achieved is more important than maternal obesity or treatment modality (metformin versus insulin).…”