Download PDF
Horm Metab Res 2023; 55(05): 295-303
DOI: 10.1055/a-2061-9441
Review

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

Dhruvil Gajera 
1   Department of Pharmacy Practice, Parul Institute of Pharmacy, Vadodara, India
,
Vishva Trivedi 
1   Department of Pharmacy Practice, Parul Institute of Pharmacy, Vadodara, India
,
Priyanshu Thaker
1   Department of Pharmacy Practice, Parul Institute of Pharmacy, Vadodara, India
,
Mrudang Rathod
1   Department of Pharmacy Practice, Parul Institute of Pharmacy, Vadodara, India
,
Abhay Dharamsi
1   Department of Pharmacy Practice, Parul Institute of Pharmacy, Vadodara, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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.

Key words

gestational diabetes mellitus - diabetes mellitus type 2  - Impaired glucose tolerance  - metabolic syndrome


Publication History

Received: 05 January 2023

Accepted after revision: 24 March 2023

Accepted Manuscript online:
24 March 2023

Article published online:
02 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 HAPO Study Cooperative Research Group. The hyperglycemia and adverse pregnancy outcome (HAPO) study. Int J Gynecol Obstet 2002; 78: 69-77
    CrossrefPubMedSearch in Google Scholar
  • 2 Kouhkan A, Najafi L, Malek M. et al. Gestational diabetes mellitus: Major risk factors and pregnancy-related outcomes: A cohort study. Int J Reprod Biomed 2021; 19: 827
    CrossrefPubMedSearch in Google Scholar
  • 3 Noctor E, Dunne FP. Type 2 diabetes after gestational diabetes: the influence of changing diagnostic criteria. World J Diabetes 2015; 6: 234
    CrossrefPubMedSearch in Google Scholar
  • 4 Grieger JA, Hutchesson MJ, Cooray SD. et al. A review of maternal overweight and obesity and its impact on cardiometabolic outcomes during pregnancy and postpartum. Therap Adv Reprod Health 2021; 15: 2633494120986544
    CrossrefPubMedSearch in Google Scholar
  • 5 Herath H, Herath R, Wickremasinghe R. Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women–A community based retrospective cohort study. PloS one 2017; 12: e0179647
    CrossrefPubMedSearch in Google Scholar
  • 6 Plows JF, Stanley JL, Baker PN. et al. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci 2018; 19: 3342
    CrossrefPubMedSearch in Google Scholar
  • 7 Toren E, Burnette KS, Banerjee RR. et al. Partners in crime: beta-cells and autoimmune responses complicit in type 1 diabetes pathogenesis. Front Immunol 2021; 12: 756548
    CrossrefPubMedSearch in Google Scholar
  • 8 Plows JF, Stanley JL, Baker PN. et al. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci 2018; 19: 3342
    CrossrefPubMedSearch in Google Scholar
  • 9 Ashcroft FM, Rohm M, Clark A. et al. Is type 2 diabetes a glycogen storage disease of pancreatic β cells?. Cell Metab 2017; 26: 17-23
    CrossrefPubMedSearch in Google Scholar
  • 10 Barbour LA, McCurdy CE, Hernandez TL. et al. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care 2007; 30: S112-S119
    CrossrefPubMedSearch in Google Scholar
  • 11 Friedman JE, Kirwan JP, Jing M. et al. Increased skeletal muscle tumor necrosis factor-α and impaired insulin signaling persist in obese women with gestational diabetes mellitus 1 year postpartum. Diabetes 2008; 57: 606
    Search in Google Scholar
  • 12 https://www.mdpi.com/1422-0067/19/11/3342/htm
    PubMed
  • 13 Chen J, Tan B, Karteris E. et al. Secretion of adiponectin by human placenta: differential modulation of adiponectin and its receptors by cytokines. Diabetologia 2006; 49: 1292-1302
    CrossrefPubMedSearch in Google Scholar
  • 14 Kishida K, Funahashi T, Shimomura I. Molecular mechanisms of diabetes and atherosclerosis: role of adiponectin. Endocr Metab Immune Disord Drug Targets (Formerly Curr Drug Targets Immune, Endocri Metab Disord) 2012; 12: 118-131
    CrossrefPubMedSearch in Google Scholar
  • 15 Bouchard L, Hivert MF, Guay SP. et al. Placental adiponectin gene DNA methylation levels are associated with mothers’ blood glucose concentration. Diabetes 2012; 61: 1272-1280
    CrossrefPubMedSearch in Google Scholar
  • 16 Augustin R. The protein family of glucose transport facilitators: It's not only about glucose after all. IUBMB Life 2010; 62: 315-333
    CrossrefPubMedSearch in Google Scholar
  • 17 Jones HN, Jansson T, Powell TL. IL-6 stimulates system A amino acid transporter activity in trophoblast cells through STAT3 and increased expression of SNAT2. Am J Physiol Cell Physiol 2009; 297: C1228-C1235
    CrossrefPubMedSearch in Google Scholar
  • 18 Radaelli T, Lepercq J, Varastehpour A. et al. Differential regulation of genes for fetoplacental lipid pathways in pregnancy with gestational and type 1 diabetes mellitus. Am J Obstet Gynecol 2009; 201: 209-e1
    CrossrefPubMedSearch in Google Scholar
  • 19 Reichetzeder C, Dwi Putra SE, Pfab T. et al. Increased global placental DNA methylation levels are associated with gestational diabetes. Clin Epigenet 2016; 8: 1-0
    CrossrefPubMedSearch in Google Scholar
  • 20 https://apps.who.int/iris/bitstream/handle/10665/85975/WHO_NMH_MND_13.2_eng.pdf
    PubMed
  • 21 Genevay M, Pontes H, Meda P. Beta cell adaptation in pregnancy: a major difference between humans and rodents?. Diabetologia 2010; 53: 2089-2092
    CrossrefPubMedSearch in Google Scholar
  • 22 Li G, Wei T, Ni W. et al. Incidence and risk factors of gestational diabetes mellitus: a prospective cohort study in Qingdao, China. Front Endocrinol 2020; 636
    CrossrefPubMedSearch in Google Scholar
  • 23 Kwak SH, Jang HC, Park KS. Finding genetic risk factors of gestational diabetes. Genom Inform 2012; 10: 239
    CrossrefPubMedSearch in Google Scholar
  • 24 Mills GW, Avery PJ, McCarthy MI. et al. Heritability estimates for beta cell function and features of the insulin resistance syndrome in UK families with an increased susceptibility to type 2 diabetes. Diabetologia 2004; 47: 732-738
    PubMedSearch in Google Scholar
  • 25 Spellacy WN, Miller S, Winegar A. et al. Macrosomia – maternal characteristics and infant complications. Obstet Gynecol 1985; 66: 158-161
    PubMedSearch in Google Scholar
  • 26 Morales-Suárez-Varela M, Peraita-Costa I, Perales-Marín A. et al. Risk of gestational diabetes due to maternal and partner smoking. Int J Environ Res Pub Health 2022; 19: 925
    CrossrefPubMedSearch in Google Scholar
  • 27 Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril 2012; 97: 18-22
    CrossrefPubMedSearch in Google Scholar
  • 28 Jenum AK, Mørkrid K, Sletner L. et al. Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. Eur J Endocrinol 2012; 166: 317-324
    CrossrefPubMedSearch in Google Scholar
  • 29 Savitz DA, Janevic TM, Engel SM. et al. Ethnicity and gestational diabetes in New York City, 1995–2003. BJOG: Int J Obstet Gynaecol 2008; 115: 969-978
    PubMedSearch in Google Scholar
  • 30 Zito G, Della Corte L, Giampaolino P. et al. Gestational diabetes mellitus: Prevention, diagnosis and treatment. A fresh look to a busy corner. J Neonatal Perinatal Med 2020; 13: 529-541
    CrossrefPubMedSearch in Google Scholar
  • 31 Tsakiridis I, Giouleka S, Mamopoulos A. et al. Diagnosis & management of gestational diabetes mellitus. Obstet Gynecol Surv 2021; 76: 367-381
    CrossrefPubMedSearch in Google Scholar
  • 32 Caissutti C, Khalifeh A, Saccone G. et al. Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?. Acta Obstet Gynecol Scand 2018; 97: 122-134
    CrossrefPubMedSearch in Google Scholar
  • 33 Rich SS, Concannon P. Role of Type 1 Diabetes-associated SNPs on autoantibody positivity in the type 1 diabetes genetics consortium: overview. Diabetes Care 2015; 38: S1-S3
    CrossrefPubMedSearch in Google Scholar
  • 34 O’Sullivan JB, Mahan CM, Charles D. et al. Screening criteria for high-risk gestational diabetic patients. Am J Obstet Gynecol 1973; 116: 895-900
    CrossrefPubMedSearch in Google Scholar
  • 35 National Diabetes Data Group. Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance. Diabetes 1979; 28: 1039-1057
    CrossrefPubMedSearch in Google Scholar
  • 36 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144: 768-773
    CrossrefPubMedSearch in Google Scholar
  • 37 Rani PR, Begum J. Screening and diagnosis of gestational diabetes mellitus, where do we stand. J Clin Diagnost Res. 2016; 10: QE01
    PubMedSearch in Google Scholar
  • 38 International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682
    CrossrefPubMedSearch in Google Scholar
  • 39 Shirazian N, Mahboubi M, Roya E. et al. Comparison of different diagnostic criteria for gestational diabetes mellitus based on the 75-g oral glucose tolerance test: a cohort study. Endocr Pract 2008; 14: 312-317
    CrossrefPubMedSearch in Google Scholar
  • 40 Bellamy L, Casas JP, Hingorani AD. et al. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373: 1773-1779
    CrossrefPubMedSearch in Google Scholar
  • 41 Ornoy A, Becker M, Weinstein-Fudim L. et al. Diabetes during pregnancy: a maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring. A clinical review. Int J Mol Sci 2021; 22: 2965
    CrossrefPubMedSearch in Google Scholar
  • 42 Yessoufou A, Moutairou K. Maternal diabetes in pregnancy: early and long-term outcomes on the offspring and the concept of “metabolic memory”. Exp Diabetes Res 2011; 218598
    PubMedSearch in Google Scholar
  • 43 Farahvar S, Walfisch A, Sheiner E. Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review. Exp Rev Endocrinol Metab 2019; 14: 63-74
    CrossrefPubMedSearch in Google Scholar
  • 44 Mierzyński R, Poniedziałek-Czajkowska E, Sotowski M. et al. Nutrition as prevention factor of gestational diabetes mellitus: a narrative review. Nutrients 2021; 13: 3787
    CrossrefPubMedSearch in Google Scholar
  • 45 Luoto R, Laitinen K, Nermes M. et al. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr 2010; 103: 1792-1799
    CrossrefPubMedSearch in Google Scholar
  • 46 Karamanos B, Thanopoulou A, Anastasiou E. et al. A relation of the Mediterranean diet with the incidence of gestational diabetes. Eur J Clin Nutr 2014; 68: 8-13
    CrossrefPubMedSearch in Google Scholar
  • 47 Badon SE, Enquobahrie DA, Wartko PD. et al. Healthy lifestyle during early pregnancy and risk of gestational diabetes mellitus. Am J Epidemiol 2017; 186: 326-333
    CrossrefPubMedSearch in Google Scholar
  • 48 Asemi Z, Tabassi Z, Samimi M. et al. Favourable effects of the dietary approaches to stop hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Br J Nutr 2013; 109: 2024-2030
    CrossrefPubMedSearch in Google Scholar
  • 49 Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World J Diabetes 2015; 6: 1033
    CrossrefPubMedSearch in Google Scholar