Etiology, Detection, Diagnosis, and Clinical Management of Gestational Diabetes Mellitus

1999 ◽  
Vol 12 (1) ◽  
pp. 65-71
Author(s):  
Beverly A. Sullivan ◽  
Scott T. Henderson ◽  
Julie M. Davis ◽  
Martin B. Steffenson
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Close Monitoring ◽  
Care Providers ◽  
Treatment Interventions ◽  
Increased Risk ◽  
Mother And Child

Healthy outcomes for both mother and child are expected and fortunately seen in most pregnancies. In some cases, serious or potentially serious problems arise during the pregnancy that mandate a need for both close monitoring and treatment interventions by health care providers. Gestational diabetes mellitus (GDM) is such a condition that may evolve during pregnancy. Women who experienced gestational diabetes during pregnancy are at increased risk of developing Type 2 diabetes as are their offspring. As defined, GDM is a type of diabetes restricted to pregnant women in whom the recognition of glucose intolerance first occurs during pregnancy.1 Physicians and pharmacists who are trained in the management of diabetes can help guide the patient with GDM through the pregnancy and after delivery, monitor her and the infant. This article reviews the current concepts pertaining to the basic pathophysiology, detection, diagnosis, and management of gestational diabetes mellitus.

scholarly journals Health Care Providers’ Perceptions of Responsibilities and Resources to Reduce Type 2 Diabetes Risk After Gestational Diabetes Mellitus

2018 ◽  
Vol 36 (2) ◽  
pp. 160-167
Author(s):  
Sumali S. Hewage ◽  
Shweta R. Singh ◽  
Claudia Chi ◽  
Jerry K.Y. Chan ◽  
Tong Wei Yew ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Diabetes Risk ◽  
Care Providers

scholarly journals Health Care Professionals’ Perspectives On Screening And Management Of Gestational Diabetes Mellitus In Public Hospitals Of South India – A Qualitative Study

2020 ◽  
Author(s):  
Biswamitra Sahu ◽  
Giridhara R Babu ◽  
Kaveri Siddappa Gurav ◽  
Maithili Karthik ◽  
R Deepa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Public Hospitals ◽  
Effective Management ◽  
Care Providers ◽  
Management Services

Abstract Background Women developing Gestational Diabetes Mellitus are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM is essential in preventing progression to type 2 diabetes mellitus. Although the burden of Gestational Diabetes Mellitus is high in India, Gestational Diabetes Mellitus screening and management is suboptimal in public hospitals. We aimed to explore the perspectives of healthcare providers regarding the barriers and facilitators from the health system context that restrict the timely screening and effective management of Gestational Diabetes Mellitus. Methods We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India's major city (Bengaluru). The interviews were conducted in the preferred language of the participants ( Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using grounded theory approach by NVivo 12 plus Results Health care providers recognized and supported the need for design and implementation of Gestational Diabetes Mellitus screening and management services. While obstetricians were aware of the national guidelines regarding screening and management; nurses mentioned that they had unmet training needs in health promotion. Barriers identified to timely screening and management of Gestational Diabetes Mellitus included unmet training needs of nurses regarding Gestational Diabetes Mellitus, delay in screening of pregnant women accessing antenatal care at private clinics initially and subsequently reporting at public hospital in late gestation, migration of pregnant women due to delivery of first born at natal home, lack of follow up system of deferred cases for gestational diabetes screening, resource deficit, and long waiting hours. Conclusion Provided the fact that there is effectiveness of Gestational Diabetes Mellitus screening and management services, there is a pressing need to develop and improve existing Gestational Diabetes Mellitus Screening and Management services to tackle the growing burden of Gestational Diabetes Mellitus in India. With the urgent need for these services, it needs to be extended to public hospitals.

scholarly journals The Pathophysiology of Gestational Diabetes Mellitus

2018 ◽  
Vol 19 (11) ◽  
pp. 3342 ◽  
Author(s):  
Jasmine Plows ◽  
Joanna Stanley ◽  
Philip Baker ◽  
Clare Reynolds ◽  
Mark Vickers
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Molecular Mechanisms ◽  
Overweight And Obesity ◽  
Chronic Hyperglycemia ◽  
Increased Risk

Gestational diabetes mellitus (GDM) is a serious pregnancy complication, in which women without previously diagnosed diabetes develop chronic hyperglycemia during gestation. In most cases, this hyperglycemia is the result of impaired glucose tolerance due to pancreatic β-cell dysfunction on a background of chronic insulin resistance. Risk factors for GDM include overweight and obesity, advanced maternal age, and a family history or any form of diabetes. Consequences of GDM include increased risk of maternal cardiovascular disease and type 2 diabetes and macrosomia and birth complications in the infant. There is also a longer-term risk of obesity, type 2 diabetes, and cardiovascular disease in the child. GDM affects approximately 16.5% of pregnancies worldwide, and this number is set to increase with the escalating obesity epidemic. While several management strategies exist—including insulin and lifestyle interventions—there is not yet a cure or an efficacious prevention strategy. One reason for this is that the molecular mechanisms underlying GDM are poorly defined. This review discusses what is known about the pathophysiology of GDM, and where there are gaps in the literature that warrant further exploration.

scholarly journals Advancements and challenges in generating accurate animal models of gestational diabetes mellitus

2013 ◽  
Vol 305 (11) ◽  
pp. E1327-E1338 ◽  
Author(s):  
Raymond C. Pasek ◽  
Maureen Gannon
Keyword(s):  
Diabetes Mellitus ◽  
Animal Models ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Well Being ◽  
Perinatal Complications ◽  
Preventative Measures ◽  
Increased Risk ◽  
Surgical Manipulation

The maintenance of glucose homeostasis during pregnancy is critical to the health and well-being of both the mother and the developing fetus. Strikingly, approximately 7% of human pregnancies are characterized by insufficient insulin production or signaling, resulting in gestational diabetes mellitus (GDM). In addition to the acute health concerns of hyperglycemia, women diagnosed with GDM during pregnancy have an increased incidence of complications during pregnancy as well as an increased risk of developing type 2 diabetes (T2D) later in life. Furthermore, children born to mothers diagnosed with GDM have increased incidence of perinatal complications, including hypoglycemia, respiratory distress syndrome, and macrosomia, as well as an increased risk of being obese or developing T2D as adults. No single environmental or genetic factor is solely responsible for the disease; instead, a variety of risk factors, including weight, ethnicity, genetics, and family history, contribute to the likelihood of developing GDM, making the generation of animal models that fully recapitulate the disease difficult. Here, we discuss and critique the various animal models that have been generated to better understand the etiology of diabetes during pregnancy and its physiological impacts on both the mother and the fetus. Strategies utilized are diverse in nature and include the use of surgical manipulation, pharmacological treatment, nutritional manipulation, and genetic approaches in a variety of animal models. Continued development of animal models of GDM is essential for understanding the consequences of this disease as well as providing insights into potential treatments and preventative measures.

scholarly journals Air pollution and gestational diabetes mellitus: evidence from cohort studies

2020 ◽  
Vol 8 (1) ◽  
pp. e000937 ◽  
Author(s):  
Xingyao Tang ◽  
Jian-Bo Zhou ◽  
Fuqiang Luo ◽  
Yipeng Han ◽  
Yoriko Heianza ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Particulate Matter ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Air Pollutants ◽  
Evidence Base ◽  
Second Trimester ◽  
Increased Risk ◽  
Particulate Matter 2.5

Exposure to different air pollutants has been linked to type 2 diabetes mellitus, but the evidence for the association between air pollutants and gestational diabetes mellitus (GDM) has not been systematically evaluated. We systematically retrieved relevant studies from PubMed, Embase, and the Web of Science, and performed stratified analyses and regression analyses. Thirteen studies were analyzed, comprising 1 547 154 individuals from nine retrospective studies, three prospective studies, and one case–control study. Increased exposure to particulate matter ≤2.5 µm in diameter (PM2.5) was not associated with the increased risk of GDM (adjusted OR 1.03, 95% CI 0.99 to 1.06). However, subgroup analysis showed positive correlation of PM2.5 exposure in the second trimester with an increased risk of GDM (combined OR 1.07, 95% CI 1.00 to 1.13). Among pollutants other than PM2.5, significant association between GDM and nitrogen dioxide (NO2) (OR 1.05, 95% CI 1.01 to 1.10), nitrogen oxide (NOx) (OR 1.03, 95% CI 1.01 to 1.05), and sulfur dioxide (SO2) (OR 1.09, 95% CI 1.03 to 1.15) was noted. There was no significant association between exposure to black carbon or ozone or carbon monoxide or particulate matter ≤10 µm in diameter and GDM. Thus, systematic review of existing evidence demonstrated association of exposure to NO2, NOx, and SO2, and the second trimester exposure of PM2.5 with the increased risk of GDM. Caution may be exercised while deriving conclusions from existing evidence base because of the limited number and the observational nature of studies.

scholarly journals Gestational Diabetes Mellitus (GDM): Current concept and a short Review

1970 ◽  
Vol 24 (1) ◽  
pp. 16-20 ◽  
Author(s):  
MT Rahman ◽  
T Tahmin ◽  
S Ferdousi ◽  
SN Bela
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Later Life ◽  
Short Review ◽  
Current Concept ◽  
Increased Risk ◽  
Develop Type

Gestational Diabetes Mellitus (GDM) is a very common and important disease occurring during pregnancy and has detrimental effect on both the mother and the baby. The mother is at increased risk of developing obstetric complications like prolonged labour, prone to develop type 2 diabetes in future and the baby is born with overweight, cause of childhood obesity and later life development of type 2 diabetes. A short review and current concept of GDM is discussed. Key words: GDM, Type 2 diabetes, Obesity, Macrosomia, Complications   doi: 10.3329/bjpath.v24i1.2877 Bangladesh J Pathol 24 (1) : 16-20

scholarly journals Gestational diabetes mellitus and the role of intercurrent type 2 diabetes on long-term risk of cardiovascular events

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jiyu Sun ◽  
Gyu Ri Kim ◽  
Su Jin Lee ◽  
Hyeon Chang Kim
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Cardiovascular Events ◽  
Cvd Risk ◽  
Increased Risk ◽  
Incident Cases

AbstractRecent studies have shown that gestational diabetes mellitus (GDM) is associated with an increased risk for cardiovascular disease. GDM has also been shown to be a risk factor for type 2 diabetes (T2DM) after pregnancy. However, there is limited evidence regarding the role of intercurrent T2DM on the relationship between GDM and future CVD. Thus, we investigated the risks of incident cardiovascular events among women with GDM during pregnancy compared to women without GDM and whether the increased CVD risk is dependent on intercurrent development of T2DM. We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service claims database. Outcomes were the first occurrence of any CVD (myocardial infarction, treatment with coronary revascularization, heart failure, and cerebrovascular disease). Cox proportional hazard models were used to assess the association between GDM and incident CVD events, using landmark analysis at 4 years. A total of 1,500,168 parous women were included in the analysis, of which 159,066 (10.60%) had GDM. At a median follow-up of 12.8 years, 13,222 incident cases of total CVD were observed. Multivariable-adjusted hazard ratio for total CVD among women with prior GDM, compared with those without GDM, was 1.08 (95% CI 1.02–1.14). Further classifying GDM by progression to T2DM in relation to total CVD risk indicated a positive association for GDM with progression to T2DM vs no GDM or T2DM (HR 1.74; 95% CI 1.40–2.15), and no statistically significant association for GDM only (HR 1.06; 95% CI 1.00–1.12). GDM with subsequent progression to T2DM were linked with an increased risk of cardiovascular diseases. These findings highlight the need for more vigilant postpartum screening for diabetes and the implementation of diabetes interventions in women with a history of GDM to reduce future CVD risk.

scholarly journals Trans-ancestry genome-wide association study of gestational diabetes mellitus highlights genetic links with type 2 diabetes

2021 ◽  
Author(s):  
Natalia Pervjakova ◽  
Gunn-Helen Moen ◽  
Maria-Carolina Borges ◽  
Teresa Ferreira ◽  
James P Cook ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Genome Wide Association ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
Increased Risk ◽  
In Pregnancy

Gestational diabetes mellitus (GDM) is associated with increased risk of pregnancy complications and adverse perinatal outcomes. GDM often reoccurs and is associated with increased risk of subsequent diagnosis of type 2 diabetes (T2D). To improve our understanding of the aetiological factors and molecular processes driving the occurrence of GDM, including the extent to which these overlap with T2D pathophysiology, the GENetics of Diabetes In Pregnancy (GenDIP) Consortium assembled genome-wide association studies (GWAS) of diverse ancestry in a total of 5,485 women with GDM and 347,856 without GDM. Through trans-ancestry meta-analysis, we identified five loci with genome-wide significant association (p<5×10-8) with GDM, mapping to/near MTNR1B (p=4.3×10-54), TCF7L2 (p=4.0×10-16), CDKAL1 (p=1.6×10-14), CDKN2A-CDKN2B (p=4.1×10-9) and HKDC1 (p=2.9×10-8). Multiple lines of evidence pointed to genetic contributions to the shared pathophysiology of GDM and T2D: (i) four of the five GDM loci (not HKDC1) have been previously reported at genome-wide significance for T2D; (ii) significant enrichment for associations with GDM at previously reported T2D loci; (iii) strong genetic correlation between GDM and T2D; and (iv) enrichment of GDM associations mapping to genomic annotations in diabetes-relevant tissues and transcription factor binding sites. Mendelian randomisation analyses demonstrated significant causal association (5% false discovery rate) of higher body mass index on increased GDM risk. Our results provide support for the hypothesis that GDM and T2D are part of the same underlying pathology but that, as exemplified by the HKDC1 locus, there are genetic determinants of GDM that are specific to glucose regulation in pregnancy.

scholarly journals Gestational diabetes: know your risk by simple and single step criteria (DIPSI)

2017 ◽  
Vol 6 (11) ◽  
pp. 5107
Author(s):  
Gita Guin ◽  
Ruchita Dadhich
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Plasma Glucose ◽  
Single Step ◽  
Public Health Issue ◽  
Oral Glucose ◽  
Care Providers ◽  
Family History Of Diabetes

Background: Gestational diabetes mellitus (GDM) has associations beyond the index pregnancy, identifying two generations at risk of future diabetes. Thus, detection of gestational diabetes mellitus becomes an important public health issue. This study aimed to estimate the prevalence of gestational diabetes mellitus by using simple and single step DIPSI criteria (Diabetes in pregnancy study group India) and risk factors associated with GDM.Methods: This cross-sectional study was carried out in 800 antenatal patients attending the antenatal clinic. These patients have given 82.5 gm mono-hydrous (75 gm anhydrous) oral glucose irrespective of the meals and their plasma glucose was estimated at 2 hr. Patients with plasma glucose value ≥140 mg/dl were diagnosed as GDM.Results: The present study estimated that the prevalence of GDM was 14.75% at their 1st visit. We found a positive association of GDM by age, BMI, hypertension and family history of diabetes. Older women had 4.5 times greater risk of GDM than younger women, obese women had 52 times higher risk of GDM than underweight women and hypertensive pregnant women had 4 times greater risk of GDM.Conclusions: It was realized that the test (DIPSI) could be easily performed in high volume hospitals comfortably and the patient were at ease as they were not fasting. Simple, cost effective tests, if made universal and available in developing country like ours will surely aid health care providers to screen, diagnose GDM and offer preventive and treatment measures at the earliest.

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