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Also called
- Gestational onset Diabetes Mellitus
- Impaired glucose tolerance during pregnancy
- Gestational carbohydrate intolerance
Causes
- Development of glucose intolerance secondary to insulin resistance (common)
-
Beta-cell dysfunction (rare):
- Autoimmune
- Genetic
Pathogenesis
- Unrecognized glucose intolerance may predate or start concurrently with pregnancy
- Ongoing pregnancy characterized by increased insulin resistance and reduced sensitivity to insulin action due to several placental factors
- Maternal hyperglycemia leads to fetal hyperinsulinemia and increased fetal growth
Initial diagnostic investigation is screening of all pregnant women using medical history, clinical risk factors, or screening blood glucose levels
For diagnosis, various protocols for diagnosing gestational diabetes exist using either fasting glucose levels or some type of oral glucose tolerance test
Complications
Maternal complications
- Spontaneous preterm birth with untreated GDM
- Traumatic complications of vaginal delivery
- Cesarean delivery
- Morbidity from operative delivery
- Gestational Diabetes associated with increased risk of metabolic syndrome
Complications for fetus
Stillbirth
- Sudden unexplained fetal death at term (stillbirth)
Macrosomia and shoulder dystocia
Excessive maternal weight gain associated with increased risk of preterm and cesarean deliveries, large for gestational age newborns, and macrosomia in women with GDM
Treatment overview
- Benefits of treatment of Gestational Diabetes may include decreased risk of preeclampsia, large for gestational age, and shoulder dystocia
- Initial management should include diet and exercise, then medications added if needed
Excercise
Planned physical activity 30 minutes/day recommended for all capable individuals
Diet
- Treat women with GDM with nutrition therapy and medication if necessary to provide maternal and fetal benefit
- Medical nutrition therapy (and exercise) is part of initial management for GDM
Benefits of treatment for Gestational Diabetes
GDM treatment may decrease risk of macrosomia, large for gestational age, shoulder dystocia, and Gestational Hypertension
