Gestational Diabetes Mellitus: Understanding and Managing a Common Condition
1. Introduction to Gestational Diabetes
Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with onset or first recognition during pregnancy, excluding women who had diabetes prior to pregnancy. Its clinical importance rests on the association with an increased risk of various adverse pregnancy outcomes including hypertensive disorders of pregnancy in the mother and macrosomia, birth trauma, neonatal hypoglycemia, and death in the fetus/neonate. Thanks to advances in understanding and treatment, the risks to fetuses and mothers can now be effectively reduced. Given that GDM usually resolves after delivery, the purpose of treatment is to promote a healthy pregnancy and inhibit the development of maternal–fetal complications.
The prevalence of gestational diabetes varies widely among different ethnic populations, averaging 7% across the USA. Ethnicity is correlated with the prevalence of gestational diabetes, as demonstrated by the high prevalence of gestational diabetes among Asian women. Other risk factors for the development of gestational diabetes include maternal obesity, increased maternal age, a family or personal history of diabetes, and excessive weight gain during pregnancy.
2. Epidemiology and Risk Factors
GDM affects approximately 7% of all pregnancies worldwide.[2][3] However, prevalence varies considerably across populations and ranges from 1% to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed.[4][5] Management is generally undertaken by a team consisting of an obstetrician, midwife, dietitian, and, if necessary, a diabetologist. The aim of management is to avoid the sequelae of GDM, as well as the progression to type 2 diabetes mellitus for the mother. Identification and appropriate treatment of GDM can significantly reduce the risk of adverse maternal and fetal outcomes.
Both environmental and genetic factors contribute to the development of GDM. Risk factors, such as advancing maternal age, being overweight or obese, a family history of diabetes, and a prior episode of GDM, are similar to those influencing the risk of type 2 diabetes. Current evidence suggests that obese pregnant women with features such as polycystic ovary syndrome are at even higher risk for developing GDM compared to non-obese pregnant women. Women born small or premature may have a higher risk of insulin resistance, adding to their susceptibility. Prior perinatal outcomes sensitive to high blood glucose levels during pregnancy, such as previous stillbirth, miscarriage, premature birth, or congenital malformation in previous pregnancies, also contribute to the risk of developing GDM.
3. Pathophysiology of Gestational Diabetes
Gestational diabetes mellitus (GDM) is a condition characterised by glucose intolerance with onset or first recognition during pregnancy. GDM arises as a consequence of increased insulin resistance in pregnancy combined with an inadequate insulin secretory response. Pregnancy is associated with increased maternal adiposity and is considered a diabetogenic state, characterised by normal insulin resistance and compensatory hyperinsulinaemia resulting in normal blood glucose levels (euglycemia). Pregnancy is associated with a progressive increase in insulin resistance beginning in midpregnancy and peaking in late pregnancy. This insulin resistance increases the maternal availability of nutrient substrates for fetal growth and development and maintains maternal glucose and free fatty acid levels in the high normal range for fetal nutrient sensing.
Insulin sensitivity, as measured by the glucose clamp technique, decreases substantially from approximately 16 to 36 weeks of pregnancy, returning to normal in the postpartum period. Placental growth hormone, produced by syncytiotrophoblasts and secreted into maternal circulation, progressively mounts during pregnancy, peaking at term. Placental growth hormone plays a key role in modulating insulin action and glucose metabolism during pregnancy. Pregnancy-induced insulin resistance arises predominantly as a result of increased placental release of counter-regulatory hormones that are part of the maternal hypothalamic-pituitary-adrenal axis. The placenta also synthesizes two hormone-like proteins—human placental lactogen (hPL) and human placental growth hormone (PGH)—whose functions include promoting maternal lipolysis and modulating insulin resistance to ensure a continual supply of glucose and nutrients for fetal growth and development.
4. Diagnosis and Screening Methods
Gestational diabetes mellitus (GDM) is defined as glucose intolerance first detected during pregnancy, regardless of severity. According to the International Diabetes Federation, 16.2% of live births were affected by Hyperglycemia in Pregnancy (HIP), with 85.1% caused by GDM. Screening procedures upon pregnancy confirmation are crucial to enable patients to undertake dietary control, physical activity, and/or insulin therapy to maintain blood glucose levels within the target range.
The predominant hormone during pregnancy, human placental lactogen, induces progressive insulin resistance, which begins in the second trimester and peaks between 24 and 26 weeks of gestation. However, there are ethnic differences in insulin sensitivity and beta cell function in pregnant women, as shown by a Chinese study. In pregnant women with low risk factors, oral glucose tolerance testing is generally not recommended, whereas women with high risk factors should undergo early screening at 12–16 weeks of gestation to identify undiagnosed diabetes mellitus. Moreover, pregnancy with human immunodeficiency virus or hepatitis B virus (HBV) coinfection is associated with a higher risk of developing GDM.
5. Clinical Implications for Maternal Health
Gestational Diabetes Mellitus (GDM), defined as high blood sugar during pregnancy, affects between 3% and 13% of pregnancies in the United States. These rates depend on the population studied and the diagnostic tests used. As the prevalence of obesity and sedentary lifestyles increases, the incidence of GDM is on the rise. Hispanic women and certain Asian subgroups experience greater incidence of GDM than non-Hispanic whites. GDM is associated with adverse outcomes including preterm birth, maternal hypertension/preeclampsia, cesarean delivery, and macrosomia.
Depending on the criteria used, between 2% and 10% of pregnancies are complicated by diabetes and up to 90% of these cases represent GDM. GDM can lead to complications for both mother and fetus. Pregnancy induces a diabetogenic environment and loss of pancreatic β-cell reserve results in GDM. Advanced maternal age, overweight/obesity, excessive gestational weight gain, family history of type 2 diabetes mellitus (T2DM), and prior GDM are common predisposing risk factors.
6. Fetal Outcomes and Risks
Although dietary measures have a significant impact on the development of GDM, there appear to be other risk factors involved in its pathogenesis that have not yet been confirmed. Primiparity and macrosomia have traditionally been considered risk factors, although evidence suggests that they are more likely to be consequences of the abnormal metabolic state during pregnancy and fetal hyperinsulinism. Further investigation into the role of diet, including the intake of macronutrients and micronutrients, is necessary.
The recognition of fetal hyperinsulinism is crucial. Women with GDM have an increased risk of developing hypertensive disorders during pregnancy, including preeclampsia and eclampsia. In addition, pre-existing diabetes during pregnancy is associated with a higher incidence of abortion, preterm delivery, dystocia, operative delivery, maternal infections, and cord prolapse. These altered maternal hormonal levels affect fetoplacental tissue, leading to overgrowth and macrosomia. The associated fetal abnormalities include nostalgic down syndrome, varying degrees of fetal abstinence syndrome, hypoglycemia, respiratory distress syndrome, congenital malformations, delayed lung development, and fetal death. Insulin is the growth hormone of the fetus and plays a role in the development of fetal fat, amino acid uptake, and glycogen storage in the liver. Derangements in glucose homeostasis, one of the essential pathways that regulate fetal growth and development, can induce excessive fetal growth during the intrauterine period.
7. Dietary Management Strategies
Diet is an essential component of treatment for women with gestational diabetes mellitus (GDM). The recommended energy intake for women with GDM is between 30 and 35 kcal/kg/day of ideal body weight per day. The suggested carbohydrate distribution is 40–50% of total calories, with fat accounting for 30–40% and protein for 20%. Carbohydrates occupy a central role in meal planning for women with GDM, mainly because carbohydrate ingestion has the most marked effect on blood glucose concentration. The following dietary guidelines may improve blood sugar control in GDM: intake of starch/cereal foods should be consumed at each meal and snacking is discouraged; sugar-sweetened beverages as part of meals are discouraged; foods rich in monounsaturated fats (MUFAs) such as olive oil and peanuts are a healthier choice and should be encouraged.
Dietary modifications specifically target carbohydrate distribution to improve blood sugar values and pregnancy outcomes. In particular, women with GDM have an improved glucose profile as well as lipid profiles when the diet is composed of at least 50% complex carbohydrates. The ideal carbohydrate intake in women with GDM is yet to be determined because suspicion has recently been raised that a diet containing >70% complex carbohydrates might have detrimental effects on blood sugar concentrations. Dietary fiber, which is generally obtained from dehulled cereals (such as wholemeal bread), fruits, and non-starchy vegetables, exerts beneficial effects on blood sugar concentrations.
8. Physical Activity Recommendations
Physical activity has wide-ranging benefits during pregnancy and can be performed safely by many women. There is no evidence that it induces miscarriage, fetal abnormality, or growth restriction. While on a holiday in the Swiss Alps, the Duke of Edinburgh, husband of Queen Elizabeth II, conceived a child while walking at high altitudes of around 13,000 feet. He also played real tennis during the entire pregnancy up to the onset of labour. Despite having had disturbed early pregnancies resulting in miscarriages, spastic quadriplegia, and Down Syndrome, the couple were blessed with a healthy baby. That pregnancy was uneventful for both mother and child.
Women with uncomplicated pregnancies can be encouraged to engage in physical exercise and recreation, as these confer significant physiological and psychological benefits, particularly during the postpartum period. Benefits include reducing the risk of pathological weight gain during pregnancy, rapid return to pre-pregnancy weight, a perception of increased vitality, reduction of pregnancy-related aches and pains, enhanced self-image, and reduced levels of anxiety and depression. In recent decades, the common medical advice for women to avoid physical activity during pregnancy has been challenged by studies demonstrating the associated benefits.
9. Insulin Therapy and Other Medications
Despite the importance and success of lifestyle management in controlling gestational diabetes mellitus (GDM), a failure rate of 20–60% has been reported. In these cases, various medications are required to bring maternal blood glucose levels within target range. The initially preferred drug is insulin; however, oral hypoglycemic drugs, including metformin and glyburide, have been used during pregnancy with minimal adverse effects reported.
Although oral agents for GDM are used infrequently because of their relative inefficiency and lack of conclusive long-term safety studies in GDM, they can reduce the need for insulin therapy and therefore improve the willingness of patients to comply with therapy and reduce costs. Evidence suggests that patients can safely use metformin or, if unable to, glyburide.
10. Monitoring Blood Glucose Levels
Monitoring blood glucose levels is essential for managing gestational diabetes mellitus (GDM). Women with GDM often check their blood sugar levels at least four times daily: after fasting overnight and one to two hours after each meal. Less frequent monitoring can be advisable during the initial days of diet therapy or insulin therapy. Special attention is required after changing insulin dosages or introducing new oral antidiabetic drugs. Random postprandial glucose testing without documented carbohydrate consumption is discouraged due to variable absorption. Proper hygiene during testing minimizes infection risk. Peripartum glucose monitoring in high-risk groups involves hourly whole blood or arterial blood glucose estimations; maintaining glucose levels between 72 and 126 mg/dL reduces neonatal hypoglycemia. During labor, frequent glucose assessment guides insulin and glucose infusion to maintain these target ranges.
The glycemic threshold for commencing insulin therapy in GDM remains controversial, with criteria proposed by the Fifth International Workshop Conference commonly applied. The American Diabetes Association recommends fasting and 1-hour postprandial targets of ≤ 95 mg/dL and ≤ 140 mg/dL, respectively. The timing of glucose measurements—whether 1-hour or 2-hour postprandial—may differ by local guidelines.
11. Postpartum Care and Follow-Up
Gestational diabetes mellitus (GDM) is a condition characterized by carbohydrate intolerance resulting in hyperglycaemia of variable severity, with onset or first recognition during pregnancy. The hyperglycaemia of GDM insidiously affects maternal health by increasing the risk of hypertension and preeclampsia during pregnancy and the woman’s risk of developing type 2 diabetes and cardiovascular disease later in life. The fetus is exposed to hyperglycaemia and is at risk of being macrosomic, with shoulder dystocia and birth injuries. Macrosomia also increases the lifelong risk of obesity, glucose intolerance and type 2 diabetes. Many women with GDM will require pharmacological treatment. Insulin is considered the gold standard, but metformin and glyburide may be used. All infants are at risk of developing neonatal hypoglycaemia, and neonates of mothers who received insulin, metformin or glyburide are at risk of being small for gestational age.
Postpartum follow-up is fraught with many competing priorities, and many women will not be motivated to be retested. Postpartum oral glucose tolerance test is effective in diagnosing persistent diabetes and identifying women at risk of subsequent type 2 diabetes. Lifestyle intervention and metformin reduce diabetes incidence by 50% in women with a history of GDM. Patient education resources and support systems for the whole family are integral to the care of women with GDM. Early diagnosis and treatment of GDM can help reduce adverse maternal and neonatal outcomes, but screening and treatment are still widely debated. Future research directions include more information on the long-term risks of the fetus, the optimal management of GDM and strategies for postpartum follow-up.
12. Long-term Implications for Mothers
Gestational diabetes mellitus (GDM) is a common metabolic disorder affecting blood sugar regulation during pregnancy and is characterized by glucose intolerance. The diagnosis has diverse physiological and clinical implications for both mother and child during pregnancy and in later life. Several studies have demonstrated the risk of developing type 2 diabetes, especially after a few weeks, as early as 6 weeks postpartum, and GDM also appears to be associated with maternal cardiovascular risk profiles. However, these adverse outcomes can be markedly reduced if GDM is detected and treated during pregnancy, rendering timely diagnosis an important step in effective long-term treatment.
Gestational diabetes is defined as glucose intolerance of any severity that starts or is first recognized during pregnancy. As the physiological demands of pregnancy progress, pregnancy hormones interfere with the activities of insulin, leading to insulin resistance. Normally, the pancreas compensates by increasing insulin production, but in women who develop GDM, this compensatory mechanism fails, resulting in failure of glucose homeostasis.
13. Long-term Implications for Children
A child born from a pregnancy complicated by GDM can face a number of health issues, both at birth and later in life. Increased risks include being born preterm, having low blood sugar levels, or developing macrosomia, which might lead to injuries during birth such as shoulder dystocia. In more severe cases, children can experience respiratory distress syndrome, stillbirth, or neonatal death. Beyond these early challenges, children are also more susceptible to developing obesity and type 2 diabetes later in life.
The increased risk in offspring is linked to both hyperglycemia and hyperinsulinemia. Overexposure to high sugar levels in the uterus can lead to more fat accumulation in the developing baby. At the same time, heightened insulin production during fetal life can foster excess fatigue and a higher risk of overweight and obesity in childhood, adolescence, and adulthood. Possible underlying causes include a pro-inflammatory state and alterations in adipose tissue development.
14. Psychosocial Aspects of Gestational Diabetes
Gestational diabetes mellitus (GDM)—a condition characterized by carbohydrate intolerance first recognized during pregnancy—contributes an estimate of 1–14% of all pregnancies in the USA. It represents the most common medical complication of pregnancy. Any degree of carbohydrate intolerance not overt diabetes occurring or recognized for the first time during pregnancy is referred to as GDM. GDM development is associated with increased maternal and fetal complications—hypertension, preeclampsia, and macrosomia—which may lead to morbidity and mortality for the mother and her child. This condition has an impact not only on the physical health of the mother and the fetus but also on the mental well-being, both during pregnancy and after delivery.
Pregnancy courses are regularly associated with significant life changes and emotional reactions that can result in either a positive or a complex process of adaptation to both physiological changes and psychological demands. Changes in lifestyle and diet during pregnancy, necessary to attain optimal carbohydrate regulation, social and familial burden, and the need for continuous support and care are factors that derive from the diagnosis of GDM and are capable of affecting the emotional and psychological health of the woman. Women with GDM often experience feelings of guilt and fear for the risks that the disease implies for the fetus. In addition, they may experience concerns related to the possibility of developing type 2 diabetes in the future and the consequent fear for their self-worth.
15. Educational Resources for Patients
16. Role of Healthcare Providers
Healthcare providers play an important role in informing mothers about gestational diabetes and providing strategies to control the condition. A multidisciplinary team that includes an endocrinologist, diabetes educator, dietitian, and obstetrician is central to ensuring optimal provision of care. Culturally sensitive education and support are critical, particularly for women from ethnic groups at high risk. Intervention nurses can play an important part in providing culturally sensitive education and support treatment through the rapidly advancing development of telecare and mHealth technologies.
Making information readily accessible is crucial to ensuring awareness of gestational diabetes. Well-informed mothers whose diabetes is well controlled are less likely to be concerned or depressed, and a lack of information has been identified as a major barrier to pregnant women in undertaking physical activity. Reading materials about the diagnosis of gestational diabetes, supplemented by appropriate Web-based resources for women, may help them develop a more accurate perception of the risks and prevent the onset of guilt, fear, and anxiety. However, reviewing Web-based information also confirms that only a few sites deal explicitly with GDM and offer specific management advice.
17. Cultural Considerations in Management
Cultural beliefs play an important role in mothers’ experience of gestational diabetes and in their care. These beliefs affect how a woman experiences gestational diabetes, the treatments she will accept, and the degree to which she is supported by their mothers-in-law during the pregnancy. Cultural considerations are also important in the pregnancy after gestational diabetes, as groups that are more culturally distinct sometimes appear to be at heightened risk for developing diabetes including the offspring of women who experienced gestational diabetes.
Incorporating culture into gestational diabetes management requires the collective effort of education systems, healthcare providers, and community support groups. Educational materials, whether printed, visual, or delivered verbally, that are culturally sensitive can aid mothers in understanding the condition and its implications. Healthcare providers need to be aware of cultural differences as well as cultural notions of time and understanding of risk in pregnancy. Likewise, counselors, advisers, and support groups can reach out in culturally valid and sensitive ways to lessen the concern of mothers and their families.
18. Emerging Research and Future Directions
In recent years, the clinical approach to screening and management of GDM has shifted, as much as research in the field has evolved. Current directives are different from other historical guidelines, yet the strongest trial performed suggests that more lenient glucose thresholds may be preferable. The trial also found that medicalized management of gestational hyperglycemia confers no proved benefit, but rather may cause harm through unnecessary caesarean sections and neonatal admissions. Ongoing research seeks to combine mortality and morbidity from GDM, to better balance potential benefits and harms of screening and treatment.
However, the large size of certain trials, despite being performed in a pragmatic and unblinded manner, render conclusive findings difficult to fully discredit. Consequently, guidelines continue to evolve in the consonance of available evidence. Support remains for the utility of the HAPO trial to inform the future of GDM management. Additionally, clinical trials are investigating whether treatment reduces preeclampsia and other pregnancy complications. Emerging insulin types with improved profiles and the advent of oral medications with enhanced glycemic effects have also broadened support for pharmacological intervention in many countries. Investigations into safe exercise programs for GDM patients further illustrate the breadth of current research in the field.
19. Case Studies and Clinical Examples
Gestational diabetes mellitus (GDM) is a condition characterized by carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Poorly controlled GDM is associated with a variety of adverse maternal and fetal outcomes, such as gestational hypertension, preeclampsia, fetal macrosomia, shoulder dystocia, and cesarean section. Hence, early diagnosis and appropriate management are essential. Although GDM typically completely resolves after delivery, it occasionally develops into overt diabetes and even when GDM resolves postpartum, long-term screening is recommended because developed glucose intolerance is at an increased risk of diabetes mellitus.
Case 1 involved a 33-year-old woman at week 24 of pregnancy with a body mass index (BMI) of 21.9 kg/m2, no prior history of glucose intolerance, but a previous delivery of a baby with macrosomia weighing 4.7 kg. A 75-g oral glucose tolerance test (OGTT) identified GDM. The patient diligently controlled her blood glucose levels through diet and physical exercise and delivered a healthy baby with a weight appropriate for gestational age, demonstrating a favorable clinical course. Case 2 concerned a 38-year-old woman at week 30 of pregnancy with a BMI of 26.7 kg/m2 who presented with exertional dyspnea, fever, and worsening renal function. An 75-g OGTT indicated overt diabetes. Despite insulin therapy, hypertensive emergency and fetal growth restriction developed, and an emergency cesarean section was performed. Subsequent investigations diagnosed CANVAS. These contrasting clinical courses exemplify the influence of early diagnosis and rigorous control of blood glucose on the outcomes of GDM.
20. Support Systems for Affected Families
The diagnosis of any type of diabetes during pregnancy can evoke fear and concern, not only for the health of the woman herself but also for the well-being of her unborn baby. The complex and demanding treatment regimen requires daily commitment and dedication from the woman. Pregnancy brings about numerous physical, emotional, and social changes, all of which can be particularly stressful when combined with a high-risk pregnancy like gestational diabetes mellitus (GDM). These added concerns, along with the typically frequent prenatal medical visits, can lead to feelings of physical, emotional, and financial strain. Ultimately, the development of GDM affects not only the women diagnosed but also their partners and entire families, highlighting the importance of strong support systems.
Support can be provided both informally and formally through family, friends, and healthcare facilities. Informal support includes emotional, spiritual, and practical assistance from loved ones, while formal support comes from healthcare providers and community counseling services. Combined, these sources of support are essential for effectively managing the disease, particularly if self-care treatments are needed. Informal support is especially critical for the physical and psychological well-being of both the mother and the fetus during pregnancy, and for the subsequent management of GDM after childbirth. The positive influence of such support can contribute to better pregnancy outcomes and lower the risk of developing type 2 diabetes later in life for both mother and child.
21. Public Health Initiatives and Awareness
Many countries now support public health campaigns aimed at raising awareness of gestational diabetes as a public health problem, calling for action to improve diagnosis, treatment, and awareness. Research suggests Western societies are aware of GDM as a health problem, but not all Asian groups are. GDM healthcare education and information undertaken by healthcare providers, including GPs, pharmacists, dietitians, obstetricians, and endocrinologists, is important.
Most women feel they are not provided with adequate education and information on GDM and face barriers to recommended lifestyle changes. Support from partners, families, and communities of support were considered integral in facilitating lifestyle changes during and post-pregnancy.
22. Comparative Analysis of Guidelines
Several studies have compared gestational diabetes mellitus (GDM) screening recommendations from various countries. Screening for GDM is among the most controversial topics in obstetrics. Guidelines differ with regard to the diagnostic criteria, population to be screened, and the timing of screening. These recommendations are mostly based on observational studies and expert opinions. A study conducted in East Asia suggested no difference in adverse maternal and neonatal outcomes when comparing early versus routine diagnosis of GDM. Current evidence does not support the universal implementation of early (before 24 weeks) screening and diagnosis of GDM.
In a systematic review and meta-analysis evaluating different screening strategies for GDM, the two-step screening with 50 g oral glucose challenge test (GCT) remains the preferable choice to reduce adverse pregnancy outcomes and should be considered the most cost-effective method. Current evidence does not strongly favor one strategy over the other; consequently, the choice of screening method is likely driven by the setting in which they are implemented and the local prevalence of GDM. Additional randomized controlled trials may help address cost-effectiveness and maternal and neonatal outcomes with universal versus risk-based screening in the first half of pregnancy.
23. Ethical Considerations in Treatment
Gestational diabetes mellitus (GDM) is glucose intolerance first recognized during pregnancy, a common pregnancy complication that may result in adverse pregnancy outcomes for mother and child. Many clinical guidelines provide recommendations on screening, diagnosis, and management of GDM. There is a controversy over the screening approaches (universal or selective screening), the diagnostic criteria, and the method of screening (one-step or two-step screening). GDM is associated with an increased risk of developing type 2 diabetes in later life, particularly in certain ethnic groups and those with a high prepregnancy body mass index, future progression to prediabetes or type 2 diabetes also depends on the management, therapy, and tests performed during the first 6 months of follow-up after delivery.
Evidence supports the harmful effects of both preconception obesity and excessive gestational weight gain (GWG) for both mother and child, so it is important to keep GWG as close as possible to the Institute of Medicine (IOM) 2009 recommendations. Unhealthy glucose tolerance status—such as GDM—is associated with a high risk of adverse pregnancy outcomes, such as gestational hypertensive disease, preeclampsia, abnormal labor, and of birth trauma during delivery, which can cause serious short-term and long-term complications. The primary treatment is dietary plans, glycemic control, and physical activity practice; when these strategies become ineffective in lowering blood glucose level, pharmacologic management should be prescribed. The effects of insulin therapy on neonatal and pregnancy complications are similar to those of oral hypoglycemic drugs; insulin therapy is particularly important in controlling blood glucose level and reducing pregnancy complications, such as pregnancy-induced hypertension.
24. Economic Impact of Gestational Diabetes
Diabetes mellitus is the most common metabolic disorder. Gestational diabetes mellitus (GDM) is a clinical entity that refers to carbohydrate intolerance of any degree of severity, with onset or first recognition during pregnancy. It is usually transient and it takes a few weeks to resolve after delivery. By definition, this category of diabetes was not clearly recognisable prior to pregnancy and does not fulfil the criteria of type 1 diabetes. Insulin resistance and impaired insulin secretion, the pathophysiological hallmarks of type 2 diabetes, have been previously reported also in GDM. Its prevalence depends on the presence of risk factors and differences in diagnostic criteria for screening and diagnosis.
Poorly controlled blood sugars during gestation have important consequence both for mother and her baby. It can increase the risk of hypertension, preeclampsia during pregnancy. Gestational diabetes is also associated with increased perinatal morbidity and mortality. The risk of fetal and neonatal macrosomia, traumatic delivery, low blood glucose in baby after birth, and need to admit child to neonatal intensive care unit are increased in diabetic mother. Therefore, it is important to screen for gestational diabetes and maintain blood sugars in target range. Gestational diabetes can be managed mainly with dietary modification, physical activity and in select patients, addition of insulin may be required. After delivery, blood sugar levels usually revert back to normal. An oral glucose tolerance test must be performed between 4–12 weeks post-delivery. Women with GDM are at increased risk of type 2 diabetes in future; therefore, periodical screening for development of diabetes should be done.
25. Patient Testimonials and Experiences
What does it feel like to be diagnosed with gestational diabetes? Kate Whitcombe of Lancashire exposed and chronicled her feelings and sometimes heart-breaking hardships when diagnosed with GDM. The touching story originally appeared in the Daily Mail. While the symptoms of gestational diabetes are often mild, the diagnosis is far from pleasant. It is akin to an emotional roller coaster, inflicting sorrow, panic, and alarm throughout the pregnancy journey. Also revealed were the experiences of two patients on the nature of gestational diabetes and the feelings associated with the diagnosis.
"More emotions than you could imagine" During a recent news segment, I was asked what it felt like to be diagnosed with gestational diabetes. While my initial reaction was to deflect the question to a healthcare professional, I understand that some viewers wanted to know the emotional impact. Consequently, I compiled a short narrative to help raise awareness among expectant mothers.
26. Conclusion
Gestational diabetes mellitus (GDM) is an increasingly common condition during pregnancy that causes high blood glucose levels. For mother and child, gestational diabetes has long-term implications. A healthy lifestyle can help with blood sugar regulation. GDM increases the risk for mother and child to develop type 2 diabetes in the future. Additional complications include hypertension and preeclampsia for mothers as well as macrosomia for fetuses. Dietary management based on individual requirements, physical activity, and insulin therapy are the most important preventive and therapeutic pillars. Postpartum care is necessary for women in order to prevent the progression of GDM to type 2 diabetes and to detect subsequent illnesses at an early stage.
Accordingly, the complications and adverse effects associated with GDM are extensive and can severely affect the individual. Women need to be shown sensitively and individually which options can contribute to risk reduction during the course of pregnancy and in the period thereafter. This requires not only all the relevant stakeholders working together, but also the development of corresponding educational tools and resources that can help to cover the knowledge gap. It needs to be borne in mind that diagnosis in pregnancy can also trigger fear, worry, negative feelings, stress, and depression in women. Not least for these reasons, extensive support for all stakeholders must be assured—both in individual situations and more broadly.
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