Austin J Endocrinol Diabetes. 2016; 3(2): 1043.
Abdullatif Taha Babakr*
Department of Medical Biochemistry, Umm Al-Qura University, Saudi Arabia
*Corresponding author: Abdullatif Taha Babakr, Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
Received: June 20, 2016; Accepted: June 21, 2016; Published: June 23, 2016
The increased prevalence of diabetes globally , and its adverse outcomes in pregnancy [1-4], has opened a new research era on the causes, mechanisms, and relationship between hyperglycemia during the course of pregnancy and maternal and fetal complications.
Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance leading to hyperglycemia of variable degree with onset or first recognized during the present pregnancy . The condition results from an increased insulin resistance observed during pregnancy, as well as defects in the compensatory increase in insulin secretion . Pregnancy, in essence, serves as a diabetogenic status and a metabolic stress, hormones during development of placenta, and in the third trimester serves as antagonist to insulin action [7-9].
The documented prevalence varies in different regions worldwide; this is due to the heterogeneous screening approaches and diagnostic criteria . The variation in prevalence was reported even in different seasons during the year . However, generally it has been estimated to reach 10 – 20% of pregnancies in populations with high risk . Recently, an increase to approximately 18% GDM cases of all pregnancies was estimated according to the recent diagnostic criteria based on the HAPO study . Primary treatment is glycemic control to prevent fetal and maternal complications, more than 80% of cases can be managed by lifestyle therapy , and insulin therapy may be needed also . Safety of oral hypoglycemic agents is still not well evidenced for this type of diabetes [16,17]. Although incidents in the medical literature was reported as early as 1823 where diabeticlike conditions observed during pregnancy and disappear afterwards, GDM as a clinical entity was born officially in 1979 when the National Diabetes Data Group (NDDG) issued an updated classification of diabetes types, including one that was present only during pregnancy [18,19].
Controversy surrounds the ideal approach for diagnosis of GDM, and the approaches recommended for screening are mainly based on expert opinions. Glucose levels in cases of GDM show progressive increment throughout the course of pregnancy, most notably in late weeks and the third trimester of pregnancy, and blood glucose estimation at that time seems to be the best detector which can differentiate pregnant women into normal and GDM cases, the exact cut off value and exact time were not yet established.
Many risk factors are known to be associated with GDM, including family history, advanced maternal age, obesity, glycosuria and others . There is no causal relationship between GDM and the different risk factors. Different risk factors have variable strengths in association with development of GDM, and the high percent of GDM cases that did not have the definite risk factor indicate its poor sensitivity. On the other hand the high percent of normal cases that have this risk factor indicate its poor specificity, and according to this, risk factors can be categorized into high, moderate and low risk factors. This will help health care providers to give more attention to definite groups of pregnant women in evaluation of glucose tolerance.
More restricted cutoff values in GTT during pregnancy seems to be justified and should be encouraged so that more less cases of GDM will be lost, and more attention should be given to pregnant women with risk factors.
Also the target and recommended glucose levels during pregnancy should be defined; this can be achieved if the degree of hyperglycemia during pregnancy associated with fetal and maternal complications is well defined. Women who follow breastfeeding were reported to have a lower incidence of developing Type 2 diabetes and breast feeding also appears to decrease the risk of developing infant obesity and impaired glucose tolerance . The benefits of breastfeeding on the reduction of fetal and maternal complications of GDM need to be validated.
An entire medical industry regarding GDM has grown up around diagnosing and treating gestational diabetes in the aims and believes that doing so prevents perinatal deaths, macrosomia in babies, increased cesarean rates and other complications. However, the current approaches of diagnosis and treatment interventions of gestational diabetes don’t fulfill most of the mentioned goals.
the greatest challenges to face is the growing number of women developing gestational diabetes as the obesity epidemic increases, the development of Type 2 DM in mothers with GDM, and prospected glucose intolerance in the offspring.
Considerable work is needed to discover the different mechanisms underlying GDM and its evolution to type-2 diabetes after pregnancy.
Genetic studies may be of great value and help to identify women whose beta cells will poorly tolerate insulin resistance, as well as women who develop poor insulin secretion during pregnancy for reasons unrelated to insulin resistance. Studies involving geneenvironment interactions will be of considerable importance as well and additional studies involving insulin action in the muscle and fat during pregnancy may help to identify causes of insulin resistance, this will be important as they relate to obesity and weight gain.
GDM is an especially attractive target for researchers and for such studies because the condition is detected during the course of pregnancy, a routine clinical care, and it provides a good opportunity to focus on the early stages of dysregulation in glucose metabolism, this may be fundamental for better understanding of the long-term pathophysiology of diabetes mellitus.
- Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015; 66: 14-20.
- Araújo JR, Keating E, Martel F. Impact of gestational diabetes mellitus in the maternal-to-fetal transport of nutrients. Curr Diab Rep. 2015; 15: 569.
- Tward C, Barrett J, Berger H, Kibel M, Pittini A, Halperin I, et al. Does gestational diabetes affect fetal growth and pregnancy outcome in twin pregnancies? Am J Obstet Gynecol. 2016; 214: 653.
- Gui J, Potthast A, Rohrbach A, Borns K, Das AM, von Versen-Höynck F. Gestational diabetes induces alterations of sirtuins in fetal endothelial cells. Pediatr Res. 2016; 79: 788-798.
- Baz B, Riveline Jp, Gautier JF. ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects. Eur J Endocrinol. 2016; 174: 43-51.
- Zhang H, Zhang J, Pope CF, Crawford LA, Vasavada RC, Jagasia SM, et al. Gestational diabetes mellitus resulting from impaired beta-cell compensation in the absence of FoxM1, a novel downstream effector of placental lactogen. Diabetes. 2010; 59: 143-152.
- Hernández-Valencia M, Zárate A. [The risk of gestational diabetes is established since fetal and postnatal period]. Ginecol Obstet Mex. 2003; 71: 60-65.
- Horsch A, Kang JS, Vial Y, Ehlert U, Borghini A. Stress exposure and psychological stress responses are related to glucose concentrations during pregnancy. Br J Health Psychol. 2016.
- Grigorakis SI, Alevizaki M, Beis C, Anastasiou E, Alevizaki CC, Souvatzoglou A. Hormonal parameters in gestational diabetes mellitus during the third trimester: high glucagon levels. Gynecol Obstet Invest. 2000; 49: 106-109.
- Zhu Y, Zhang C. Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective. Curr Diab Rep. 2016; 16: 7.
- Moses RG, Wong VC, Lambert K, Morris GJ, San Gil F. Seasonal Changes in the Prevalence of Gestational Diabetes Mellitus. Diabetes Care. 2016.
- Galtier F. Definition, epidemiology, risk factors. Diabetes Metab. 2010; 36: 628-651.
- Weinert LS. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care. 2010. 33: 97.
- Basevi V, Di Mario S, Morciano C, Nonino F, Magrini N. Comment on: American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care 2011; 34: 11-61.
- Klein J, Charach R, Sheiner E. Treating diabetes during pregnancy. Expert Opin Pharmacother. 2015; 16: 357-368.
- Singh AK, Singh R. Metformin in gestational diabetes: An emerging contender. Indian J Endocrinol Metab. 2015; 19: 236-244.
- Malek R, Davis SN. Pharmacokinetics, efficacy and safety of glyburide for treatment of gestational diabetes mellitus. Expert Opin Drug Metab Toxicol. 2016; 12: 691-699.
- Gabbe SG. The gestational diabetes mellitus conferences. Three are history: focus on the fourth. Diabetes Care. 1998; 21: 1-2.
- Hadden DR. A historical perspective on gestational diabetes. Diabetes Care. 1998; 21: 3-4.
- Zhang C, Rawal S, Chong YS. Risk factors for gestational diabetes: is prevention possible? Diabetologia. 2016; 59: 1385-1390.
- Gunderson EP. The role of lactation in GDM women. Clin Obstet Gynecol. 2013; 56: 844-852.