Health Tips

Dangers of Gestational Diabetes Mellitus (GDM)

Gestational diabetes is a type of diabetes that only happens during and/or after pregnancy. Pregnant mothers are often worried about this, if they would get it or if it will persist after pregnancy or if it has any effects on their precious child. So, how will you know if you are at risk or if there is a way to prevent it? There are many risk factors for diabetes, and in this day and age, it is hard to completely be free from all the risk (apparently). Therefore, knowing the risk and screening for diabetes is important in order to prevent the possible complications both to the child and mother. 

Risk factors

• Personal history of impaired glucose tolerance, A1C ≥5.7 percent, impaired fasting glucose, or gestational diabetes mellitus in a previous pregnancy.

• Member of one of the following ethnic groups, which have a high prevalence of type 2 diabetes: Hispanic American, African American, Native American, South or East Asian, Pacific Islander.

• Family history of diabetes, especially in first-degree relatives .

• Prepregnancy weight ≥110 percent of ideal body weight or BMI >30 kg/m2, significant weight gain in early adulthood and between pregnancies , or excessive gestational weight gain during the first 18 to 24 weeks

• Older maternal age (>35 years of age).

• Previous unexplained perinatal loss or birth of a malformed infant.

• Glycosuria at the first prenatal visit.

• Previous birth of an infant ≥4000 or 4500 g (approximately 9 or 10 pounds).

• High density lipoprotein <35 mg/dL (0.90 mmol/L), triglyceride >250 mg/dL (2.82 mmol/L).

• Medical condition/setting associated with the development of diabetes, such as metabolic syndrome, polycystic ovary syndrome, current use of glucocorticoids, hypertension or cardiovascular disease, acanthosis nigricans.

• Multiple gestation.

Screening 

• Women with prediabetes (A1C > 5.7 is suggestive of impaired glucose intolerance) in early pregnancy develop gestational diabetes mellitus when screened and tested later in pregnancy.

• Patients with prediabetes should be tested yearly

• Women diagnosed with GDM should have lifelong testing every 3 years

What are the possible complications of gestational diabetes?

To the mother:

• Preeclampsia, gestational hypertension

• Hydramnios

• Maternal and infant birth trauma

• Operative delivery (cesarean, instrumental)

To the child: 

• Macrosomia and large for gestational age infant

• Perinatal mortality

• Fetal/neonatal hypertrophic cardiomyopathy

• Neonatal respiratory problems and metabolic complications (hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia)

• adolescent and adult offspring are at risk of long-term sequelae, such as

  •  Obesity

  •  Abnormal glucose tolerance

  • Hypertension

  • Metabolic syndrome

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Reference :

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653418/

2. https://www.uptodate.com/contents/diabetes-mellitus-in-pregnancy-screening-and-diagnosis?search=gestational-diabetes&source=search_result&selectedTitle=3~86&usage_type=default&display_rank=3

Picture credit:

1. https://www.eventbrite.com/e/gestational-diabetes-for-parents-tickets-70405277079

2. https://www.uspharmacist.com/article/managing-gestational-diabetes--the-clinical-pharmacists-role-in-a-patientcentered-medical-home-model

3. https://rednose.org.au/news/are-you-at-risk-of-gestational-diabetes

4. https://care.diabetesjournals.org/content/42/Supplement_1/S13.figures-only

5. https://monarchmedtech.com/blog/managing-gestational-diabetes-during-and-after-pregnancy/

6. https://www.medgadget.com/2018/04/fetal-macrosomia-market-highlight-by-diagnosis-and-treatment-healthy-growth-rate-of-4-1-in-worldwide-with-leading-player-forecast-to-2023.html 

7. https://healthservehhc.co/newborn-jaundice/

Written by

Dr. Jessamine Chong Sze Lynn