Under physiological circumstances, placental hormones, increased maternal adiposity, increased pancreatic secretion of insulin, as well as several other factors, together induce a state of insulin resistance in the mother midway through pregnancy [1] [2]. Due to still unknown reasons, some women progress to a state of permanent insulin resistance and develop diabetes in pregnancy.This is described as glucose intolerance that was either unrecognized or absent before pregnancy (the terms pre-gestational diabetes, or overt diabetes are used as well) [1] [2] [3]. Diabetes in pregnancy affects between 2-5% of all pregnant women, and various risk factors have been established: African American, Hispanic and Asian ethnicity (all predispose to a higher rate of diabetes mellitus type 2), preexisting hypertension, history of unexplained miscarriages and stillbirths, a positive family history for diabetes mellitus, obesity, older maternal age, polycystic ovarian syndrome (POS), macrosomia (birth weight of more than 4000 g) of babies born from previous pregnancies, and of course, prior history of diabetes in pregnancy [1] [4]. Although not always, the clinical presentation of increased glucose intolerance is practically absent, as the majority of women are asymptomatic [1]. However, numerous maternal and fetal complications are described in the absence of an early diagnosis and adequate therapy. Women who develop diabetes in pregnancy suffer from recurrent urinary tract infections (UTIs) and may develop hypertension, preeclampsia or eclampsia, a life-threatening disorder [1] [2] [4] [5]. Moreover, the risk of preterm labor is increased as a result of polyhydramnios that frequently develops [2] [4]. On the other hand, excessive fetal growth resulting in macrosomia is virtually always a complication of GDM, which predisposes fetuses to metabolic abnormalities and injuries during delivery (eg. shoulder dystocia and the frequent need for cesarean delivery), while neonatal metabolic changes (hyperbilirubinemia, hypoglycemia, and respiratory distress) are also common [4] [5]. In addition to short-term adverse events, diabetes mellitus can persist even after pregnancy, and a high incidence of cardiovascular diseases in mothers has been reported [1] [2] [4] [5].

• Weight Gain

  We now need to target optimization of maternal body mass index before pregnancy and put a greater focus on gestational weight gain through education and monitoring. [ncbi.nlm.nih.gov]

  A population-based comparison between actual maternal weight gain and the Institute of Medicine weight gain recommendations in singleton pregnancies. J Perinat Med. 2016;44:389–92. [degruyter.com]

  Overall, we consider the results of this comparison as confirmatory of the maternal weight gain and outcomes related to birth weight reported in the first two. [doi.org]

• Fatigue

  Symptoms of Type 1 may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. [americanpregnancy.org]

  Other symptoms may include: Blurred vision Fatigue Frequent infections, including those of the bladder, vagina, and skin Increased thirst Increased urination Gestational diabetes most often starts halfway through the pregnancy. [nlm.nih.gov]

• Collapse

  Surfactant is a protein that keeps the small air sacs in the lungs from collapsing. Pregnancy can make health complications associated with diabetes worse. Some can be life-threatening. [marchofdimes.org]

  In general, we used the BMI/weight categories for normal, overweight, obese, and severely obese as defined by each study ( Table 1 ); in two studies, narrow intervals were collapsed into grouping that more appropriately fit overweight, obese, and severely [doi.org]

  Collapse all Expand all Antecedentes La diabetes mellitus gestacional (DMG) es una afección médica frecuente que complica el embarazo y causa resultados adversos maternos y fetales. [cochranelibrary.com]

• Trisomy 21

  No genetic test can test for your baby’s chances of developing Type 1 diabetes, however – these tests can only look for conditions, like Down Syndrome (aka trisomy 21), that are caused by chromosomal abnormalities. 5. [asweetlife.org]

• Malnutrition

  […] and parasitic diseases NEC 647.8 inflammation injury 648.9 insufficient weight gain 646.8 insulin resistance 648.8 intrauterine fetal death (near term) NEC 656.4 malaria (conditions classifiable to 084 ) 647.4 malformation, uterus (congenital) 654.0 malnutrition [icd9data.com]

  The suggested causes of infertility present in these women were amenorrhea, uterus and Graafian follicles atrophy and malnutrition [ 3, 4 ]. [dmsjournal.biomedcentral.com]

• Respiratory Distress

  Distress Syndrome, Newborn/epidemiology Respiratory Distress Syndrome, Newborn/metabolism Respiratory Sounds Respiratory Tract Diseases/epidemiology* Respiratory Tract Diseases/metabolism [ncbi.nlm.nih.gov]

  Macrosomia itself is associated with numerous adverse fetal outcomes including shoulder dystocia, birth injury, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome and NICU admissions, asphyxia and death. [clinicaltrials.gov]

  distress) are also common. [symptoma.com]

  Fetal macrosomia and infant respiratory distress syndrome, cardiomyopathy, hypoglycemia, hypocalcemia, hypomagnesemia, polycythemia, and hyperviscosity all can occur as a result of maternal hyperglycemia and are discussed in detail. [doi.org]

• Overeating

  We generated a comprehensive epidemiological profile of diabetes in pregnancy over a 10-year period among the First Nations population of Alberta, Canada. [ncbi.nlm.nih.gov]

• Increased Appetite

  appetite Increased thirst Excessive urination Severe cases can cause ketoacidosis Non-insulin dependent diabetes mellitus (NIDDM) Type II diabetes Classically seen in adults who are overweight Insulin is present but insulin receptors unresponsive Gestational [en.wikibooks.org]

  Pregnancy hormones decrease fasting glucose levels, increase fat deposition, delay gastric emptying and increase appetite. However, over the course of pregnancy, postprandial glucose concentrations increase as insulin resistance increases. [patient.info]

• Jaundice

  Jaundice is more common in newborns of mothers who had diabetes during their pregnancy. With jaundice, the skin and whites of the eyes turn yellow. Jaundice usually goes away, but your baby may need to be placed under special lights to help. [web.archive.org]

  […] with diabetes You’re Native American, Pacific Islander, Mexican, Indian, or Asian If untreated, diabetes during pregnancy can raise the chance of: Stillbirth (death of a baby before or during birth) Serious birth defects Low blood sugar in your baby Jaundice [msdmanuals.com]

  Their babies are also at increased risk for complications, including macrosomia (high birth weight), higher rates of miscarriage and stillbirth, birth defects, delivery complications, and jaundice. [health.ucsd.edu]

• Neonatal Jaundice

  […] resuscitation (positive‐pressure ventilation, cardiac compression, or drug therapy) admission to neonatal intensive care unit or special care unit neonatal hypoglycaemia (less than 2.5 mmol/L) neonatal jaundice neonatal infection neonatal hypocalcaemia [cochranelibrary.com]

  jaundice (hyperbilirubinaemia) Neonatal jaundice (hyperbilirubinaemia) ‐ four trials ( Crowther 2005 ; Elnour 2008 ; Garner 1997 ; Landon 2009 ) found no evidence of a difference in the risk for hyperbilirubinaemia between infants exposed to the lifestyle [doi.org]

• Visual Impairment

  For those who develop visual impairment, referral is made to consultant ophthalmologists, Low Vision Clinics or community Visual Impairment Teams, as appropriate. [archive.niassembly.gov.uk]

  Laser photocoagulation for severe nonproliferative or proliferative retinopathy prior to pregnancy reduces the risk of visual impairment in pregnancy (34) ; if not performed prior to pregnancy, it is still considered safe to receive during pregnancy. [guidelines.diabetes.ca]

• Increased Birth Weight

  There is no agreement on the glycaemic threshold for these adverse outcomes - indeed, large studies have indicated a strong, continuous association of maternal glucose levels (below those diagnostic of diabetes) with increased birth weight, and significant [patient.info]

  There were strong associations with birth weight above the 90th percentile that increased across the increasing glycemia categories. [content.nejm.org]

• Hunger

  Increased hunger comes along with pregnancy as well, but sharp increases in hunger that are not normal could be a sign of diabetes. This symptom is referred to as polyphagia. Watch blood pressure levels. [babymed.com]

  Symptoms of Type 1 may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. [americanpregnancy.org]

  Often, women have no symptoms of diabetes (increased thirst, increased hunger, increased urination, weight loss or gain) and screening is the only way to identify high glucose levels. [livescience.com]

  This may include insulin if needed Discusses exams or tests that may be required Dietitian: Assesses blood sugars, ketones, weight and hunger Changes are made to the your eating plan as needed Answers any food related questions Discusses insulin (if needed [bcwomens.ca]

  The patient experiences increased hunger due to the excess insulin release as a result of elevated glucose levels. This insulin release further decreases insulin receptors due to elevated hormonal levels. [web.archive.org]

• Cesarean Section

  Rates of elective cesarean section were similar between groups but greater than in controls, emergency cesarean section was increased in women with type 1 diabetes. [ncbi.nlm.nih.gov]

  However, this bariatric surgery was associated with anemia complicating pregnancies that followed it without decreasing the rates of cesarean sections. [degruyter.com]

  Untreated diabetes -- whether it was present before pregnancy or developed during pregnancy -- significantly increases your risk for high blood pressure, preeclampsia, toxemia and cesarean section. [livehealthy.chron.com]

  After introduction of the screening/ treatment program, the prevalence of macrosomia in 1992 was 7% and the cesarean section rate had dropped from 30 to 20%. [doi.org]

  Wickstrom also learned what it means to have a large baby (the delivery was tough going); this time around, she may have a cesarean section. "If I had gone back, I would have had a C-section," she says. [diabetesforecast.org]

• Confusion

  SUMMARY STATEMENTS: Recommendations It is recognized that the use of different diagnostic thresholds for the "preferred" and "alternative" strategies could cause confusion in certain settings. [ncbi.nlm.nih.gov]

  The answer to this situation is complicated by problems of definition, confused by spontaneous remissions and hindered by lack of well documented longitudinal studies with the available diagnostic tools, which are, unfortunately, far from ideal. [nejm.org]

  The symptoms of DKA include stomach pain, nausea, vomiting, and confusion. Your healthcare provider may suggest that you test the levels of ketones in your urine when your blood sugar level is high. [drugs.com]

  Hypoglycemia, if severe, causes confusion and loss of consciousness and can occur without any warning. [msdmanuals.com]

Signs and symptoms of diabetes in pregnancy may not be apparent until delivery or until severe complications occur. For this reason, a thorough patient history is a vital step in assessing risk factors, after which screening methods should be implemented. The debate regarding screening protocols for diabetes in pregnancy is ongoing, with many authors suggesting that apart from low-risk individuals (Caucasian women under 25 years of age, a low body mass index - BMI, and no previous signs of glucose intolerance), serum glucose levels must be evaluated in all pregnant women [1] [2] [3] [4] [6] [7]. Numerous screening guidelines exist for diabetes in pregnancy, including those created by the National Diabetes Data Group (NDDG), American Diabetes Association (ADA), International Association of Diabetes and Pregnancy Study Groups (IADPSG), American College of Obstetricians and Gynecologists and several other [3] [5] [6]. However, the criteria formulated by the World Health Organization (WHO), updated in 2013, are most widely accepted. They recommend screening of all pregnant women by conducting an oral glucose tolerance test (OGTT) with 75g of glucose and subsequent serum measurements [3]. If fasting glucose levels are > 5.1 mmol/L or if levels after 1 hour are > 10 mmol/L, or if levels after 2 hours are > 8.5 mmol/L, a diagnosis of diabetes in pregnancy can be made [3]. Serum evaluation of hemoglobin A1c (HbA1C) is also proposed as a diagnostic tool for confirming diabetes in pregnancy, and the cut-off value of ≥48 mmol/mol (6.5%) was accepted as a supportive criterion for this condition [6].

• Hyperglycemia

  Despite intensive outpatient therapy, women with diabetes often require inpatient diabetes management prior to delivery as maternal hyperglycemia can significantly increase neonatal risk of hypoglycemia. [ncbi.nlm.nih.gov]

  In summary, among a large multiethnic U.S. population we found that increasing hyperglycemia in pregnancy and fasting hyperglycemia, in particular, are associated with an increased risk of childhood obesity. [doi.org]

  The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Intl J Gynaecol Obstet 2002 ; 78 : 69 – 77 ↵ ↵ HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations with neonatal anthropometrics. [care.diabetesjournals.org]

• Hypoglycemia

  Hypoglycemia education important before and during pregnancy to prevent hypoglycemia Women with type 1 diabetes are at risk for ketoacidosis At lower blood glucose levels than in the nonpregnant state Provide education on prevention and treatment of [ndei.org]

  Despite intensive outpatient therapy, women with diabetes often require inpatient diabetes management prior to delivery as maternal hyperglycemia can significantly increase neonatal risk of hypoglycemia. [ncbi.nlm.nih.gov]

  What are hypoglycemia and hyperglycemia, and how can they affect my pregnancy? Hypoglycemia and hyperglycemia are both common in women with preexisting diabetes. Hypoglycemia occurs when blood glucose levels are too low. [americanpregnancy.org]

  In practice, it may be challenging for women with type 1 diabetes to achieve these targets without hypoglycemia, particularly women with a history of severe hypoglycemia or hypoglycemia unawareness. [care.diabetesjournals.org]

• Hypertriglyceridemia

  Pregnancy associated hypertriglyceridemia in normal and diabetic women: differences in insulin-dependent, non-insulin dependent and gestational diabetes. Diabetes. 1982;31:1092–7. [degruyter.com]

  This may help to recognize patients with higher risk of hypertriglyceridemia (those with poorly controlled DM and albuminuria) [ 107 ]. [link.springer.com]

• Glucose Decreased

  The decreased β-cell mass was accompanied by increased blood glucose, decreased plasma insulin, and impaired glucose tolerance. [doi.org]

The optimum treatment for HNF1A/HNF4A maturity-onset diabetes of the young and ATP-sensitive potassium (K ATP ) channel neonatal diabetes, outside pregnancy, is sulfonylureas, but there is little evidence regarding the most appropriate treatment during [ncbi.nlm.nih.gov]

Any specific treatment versus routine antenatal care (subgroups by type of specific treatment) Comparison 2. [doi.org]

Management [ 5, 12 ] Treatment of GDM and good glycaemic control reduce serious perinatal morbidity and may also improve the woman's health-related quality of life [ 13, 14 ]. It is often controversial as to when GDM requires treatment. [patient.info]

Gestational diabetes: problems in classification and implications for long-range prognosis. Adv. Exp. Med. Biol. 1985;189:47-63. http://doi.org/bsds. [ Links ] 30. American College of Obstetricians and Gynecologists. [scielo.org.co]

HbA1c for diagnosis and prognosis of gestational diabetes mellitus. Diabetes Res Clin Pract. 2015;110:38-43. https://doi.org/10.1016/j.diabres.2015.07.014 Khalafallah A, Phuah E, Al-Barazan A, Nikakis I, Redford A, Clarkson W. et al. [revista.fecolsog.org]

Prognosis The perinatal risks to mother and baby are similar to those with known diabetes, mainly relating to the problems of a large baby. Treatment of GDM is effective in reducing macrosomia, pre-eclampsia and shoulder dystocia [ 19 ]. [patient.info]

Follow-up and prognosis Gestational diabetes resolves postpartum in more than 90% of women. In general, all insulin and oral hypoglycaemic drugs are ceased immediately postpartum with ongoing blood glucose monitoring until discharge from hospital. [nps.org.au]

The genetic etiology of gestational diabetes mellitus has largely been found to overlap that of T2D. [ncbi.nlm.nih.gov]

The clinical role of maternal hyperglycemia below the threshold for the diagnosis of gestational diabetes (GDM) in the etiology of macrosomia remains an area of controversy. [doi.org]

Despite its incompletely understood etiology, early recognition is mandatory in order to reduce the risk of many maternal and fetal complications. Repeated measurements of serum glucose levels are needed to make the diagnosis. [symptoma.com]

Etiology Mutations in the PHOX2B gene are found in a significant number of patients with Haddad syndrome. The documents contained in this web site are presented for information purposes only. [orpha.net]

Asthma/metabolism Bronchopulmonary Dysplasia/epidemiology Bronchopulmonary Dysplasia/metabolism Child Diabetes, Gestational/epidemiology* Diabetes, Gestational/metabolism Disease Models, Animal Female Hernias, Diaphragmatic, Congenital/epidemiology Hernias [ncbi.nlm.nih.gov]

Mitchell, Descriptive Epidemiology of Non‐syndromic Complete Atrioventricular Canal Defects, Paediatric and Perinatal Epidemiology, 26, 6, (515-524), (2012). ZHIXIAN SUI, ROSALIE M. GRIVELL and JODIE M. [doi.org]

Barriers were poor socioeconomic status, lack of family, peer and community support, effects of pregnancy, complicated therapeutic regimen, pathophysiology of diabetes, cultural and religious beliefs, and poor health care system. [ncbi.nlm.nih.gov]

Having fetal hyperinsulinism is a risk factor for development of both obesity and abnormal glucose metabolism, and might be implicated in pathophysiology. [doi.org]

Prevention You can lower your chance of getting gestational diabetes by losing extra weight before you get pregnant if you are overweight. Being physically active before and during pregnancy also may help prevent gestational diabetes. [niddk.nih.gov]

Prevention Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. [who.int]

If you also limit sweets and fats, you may prevent your prediabetes from becoming a problem for your developing baby’s health. [livestrong.com]

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2. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115(3):485-491.
3. Agarwal MM. Gestational diabetes mellitus: An update on the current international diagnostic criteria. World J Diabetes. 2015;6(6):782-791.
4. Alfadhli EM. Gestational diabetes mellitus. Saudi Medical Journal. 2015;36(4):399-406.
5. Rani PR, Begum J. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. J Clin Diagn Res. 2016;10(4):QE01-QE04.
6. Renz PB, Cavagnolli G, Weinert LS, Silveiro SP, Camargo JL. HbA1c Test as a Tool in the Diagnosis of Gestational Diabetes Mellitus. Wagner B, ed. PLoS ONE. 2015;10(8):e0135989.
7. Karagiannis T, Bekiari E, Manolopoulos K, Paletas K, Tsapas A. Gestational diabetes mellitus: why screen and how to diagnose. Hippokratia. 2010;14(3):151-154.