Gestational Diabetes

Gestational diabetes is a condition in which hyperglycemia, or high blood sugar, occurs during pregnancy in patients without a previous diagnosis of diabetes,1,2 and it is present in about 2 to 10 percent of pregnancies in the United States (US).3 Placental and local hormones, including estrogen, progesterone, cortisol, placental lactogen, leptin, and placental growth hormone, promote a state of insulin resistance at about 20 to 24 weeks into the pregnancy, which can lead to the development of gestational diabetes in certain individuals.1,2,4 

Symptoms and Risk Factors

Typically, gestational diabetes does not have any symptoms;3,4 as such, it is recommended that all pregnant individuals without a history of Type 1 or Type 2 diabetes get screened for gestational diabetes.2,5 The International Association of Diabetes and Pregnancy Study Group (IADPSG) recommends that pregnant persons undergo a fasting plasma glucose (FPG) test at their first prenatal visit, and that those with FPG less than 92mg/dL undergo a two-hour 75g oral glucose tolerance test (OGTT) between 24 and 28 weeks of gestation, with one abnormal glucose reading required for a gestational diabetes diagnosis.2 The US Preventive Services Task Force recommends that all patients undergo the two-step approach, as evidence on the efficacy of screening before 24 weeks is insufficient.5

Risk factors for gestational diabetes include maternal age over 25 years, family or personal history of gestational diabetes, previous delivery of a child with macrosomia (weighing over 10 pounds), presence of overweight or obesity, presence of polycystic ovary syndrome (PCOS), and being of African American, Asian American, Native American, Hispanic or Latino, or Pacific Islander descent.1,2,4–6 Recent research has indicated that gestational diabetes occurs more frequently in the summer than in winter,1,2 and one study found that in-vitro fertilization led to a 50-percent increase in incidence of gestational diabetes.1

Impact on Long-term Health

Although insulin levels typically return to pre-pregnancy levels within several days of delivery,2,4 gestational diabetes can have lasting effects on both parent and child. Individuals with gestational diabetes have a significantly increased risk of developing Type 2 diabetes, compared to those without gestational diabetes.2,7,8 One study found that risk of Type 2 diabetes remains elevated for over 35 years, and each additional pregnancy with gestational diabetes further increases this risk.8 Gestational diabetes is also associated with an increased risk of cardiovascular disease,2,7 as well as cardiovascular risk factors, including hypertension, dyslipidemia, and metabolic syndrome.7 Gestational diabetes has also been identified as a risk factor for antenatal depression,2 malignancies, ophthalmic disease, and renal disease.7 

Gestational diabetes can lead to macrosomia in the infant, as high blood glucose in the parent causes extra insulin production in the infant; the excess blood glucose is then converted into fat.1,4,9 This extra insulin production can contribute to beta-cell dysfunction and insulin resistance.1 Macrosomia can lead to a difficult birth, putting the infant at risk of shoulder or nerve damage, and potentially requiring delivery by cesarean section.1,4,9 After delivery, these infants have an increased risk of hypoglycemia due to previous reliance on the parent’s hyperglycemia.1,4,9 Infants born to parents with gestational diabetes have a higher risk of developing Type 2 diabetes and obesity,2,7,9 as well as cardiovascular disease and metabolic disorders.2  

Treatment

The goal of gestational diabetes treatment is to manage blood glucose levels, and this is typically done through diet and exercise, although some individuals may need pharmacological treatment. The American Diabetes Association (ADA) recommends general glycemic goals of 95mg/dL or less before a meal, 140mg/dL or less one hour after a meal, and 120mg/dL or less two hours after a meal.10 It is recommended that patients eat every 2 to 3 hours, and the ADA cautions against going more than 8 to 10 hours without eating overnight, as that can cause nocturnal hypoglycemia and morning ketosis.1,11 In general, the diet should consist of complex carbohydrates, nonstarchy vegetables, and lean protein, and fats should be eaten in moderation.1,11,12 Low- to moderate-intensity exercise is also recommended.1,3 However, it is important to talk to a doctor to create an individualized diet and exercise plan.

Sources

  1. Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational diabetes mellitus—recent literature review. J Clin Med. 2022;11(19):5736. 
  2. Plows JF, Stanley JL, Baker PN, et al. The pathophysiology of gestational diabetes Mellitus. Int J Mol Sci. 2018;19(11):3342.
  3. Centers for Disease Control and Prevention. Gestational diabetes. Reviewed 10 Aug 2021. https://www.cdc.gov/diabetes/basics/gestational.html. Accessed 9 Nov 2022.
  4. Stanford Medicine Children’s Health. Gestational diabetes. https://www.stanfordchildrens.org/en/topic/default?id=gestational-diabetes-mellitus-gdm-85-P00337. Accessed 9 Nov 2022.
  5. United States Preventive Services Task Force. Final recommendation statement: gestational diabetes: screening. 10 Aug 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening. Accessed 9 Nov 2022.
  6. Centers for Disease Control and Prevention. Diabetes risk factors. Reviewed 5 Apr 2022. https://www.cdc.gov/diabetes/basics/risk-factors.html. Accessed 9 Nov 2022.
  7. Sheiner E. Gestational diabetes mellitus: long-term consequences for the mother and child grand challenge: how to move on towards secondary prevention? Front Clin Diabet Health. 2020;1:546256.
  8. Diaz-Santana MV, O’Brien KM, Park YM,et al. Persistence of risk for Type 2 diabetes after gestational diabetes mellitus. Diabetes Care. 2022;45(4):864–870.
  9. American Diabetes Association. How gestational diabetes can impact your baby. https://diabetes.org/diabetes/gestational-diabetes/how-will-this-impact-my-baby. Accessed 9 Nov 2022.
  10. American Diabetes Association. Gestational diabetes: treatment and perspective. https://diabetes.org/diabetes/gestational-diabetes/how-to-treat-gestational-diabetes. Accessed 10 Nov 2022.
  11. Kaiser Permanente. Meal planning with gestational diabetes. https://mydoctor.kaiserpermanente.org/ncal/article/meal-planning-with-gestational-diabetes-1853019. Accessed 10 Nov 2022.
  12. MedlinePlus. Gestational diabetes diet. https://medlineplus.gov/ency/article/007430.htm. Accessed 10 Nov 2022.    

 

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