Gestational diabetes mellitus (GDM) has a range of risk factors and is associated with a frightening spectrum of maternal and neonatal possible outcomes.

The recognized risk factors for GDM are higher body mass index (BMI) before pregnancy, higher BMI at 28 weeks of gestation, maternal age over 25 years, family history of diabetes mellitus, past history of GDM, multiparity, twin/multiple pregnancy, polycystic ovarian syndrome, and ethnicities such as Asian, Hispanic, or African-American [1] [2] [3] [4]. Of note, the pre-pregnancy BMI of Asian women have a higher bearing on insulin resistance than that of Caucasian women and they experience insulin resistance at much lower BMIs than do their European counterparts [5].

Women who suffer from GDM experience a range of adverse effects during pregnancy. This is generally because GDM places them at a higher risk of experiencing pregnancy-related complications such as the need for caesarian/ operative vaginal delivery, pregnancy-induced hypertension, preeclampsia, and eclampsia. These women also experience adverse effects following pregnancy, most notably the increased likelihood of developing type 2 diabetes mellitus.

The undesirable effects faced by the child due to maternal GDM are macrosomia, shoulder dystocia, neonatal hypoglycemia, hyperbilirubinemia, increased risk of stillbirth, and increased risk of developing diabetes mellitus and obesity in early life [6] [7].

• Weight Gain

  AIMS: To assess the association of gestational weight gain or loss with adverse pregnancy outcome among women with gestational diabetes mellitus (GDM). [ncbi.nlm.nih.gov]

  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]

• Falling

  “Sometimes women don’t fall into the at-risk category, and in these circumstances, we usually catch that they have it through seeing extra glucose in the urine, if she looks like she’s carrying large for her dates, or if there is extra water around the [independent.ie]

  Remember insulin requirements increase progressively from the 2nd trimester until the last month of gestation, when a slight fall-off may be noted Hypoglycemia and loss of awareness is common in early pregnancy. [diabetes.co.uk]

  After your baby is born After the baby is born, insulin requirements fall and the diabetes disappears, unless it was coincidental that either type 1 or type 2 diabetes developed during the pregnancy. [healthywa.wa.gov.au]

• Fatigue

  Women may experience blurred vision, fatigue, vaginal infections, increased thirst, frequent urination, and nausea. Blood sugar levels will usually return to normal levels after delivery. [virtua.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]

  Signs and symptoms can include: Sugar in urine (revealed in a test done in your doctor’s office) Unusual thirst Frequent urination Fatigue Nausea Frequent vaginal, bladder, and skin infections Blurred vision Who gets gestational diabetes, and why do I [americanpregnancy.org]

  Here are some possible signs of gestational diabetes that should be brought to your doctor’s attention: Blurred vision Tingling or numbness in the hands and/or feet Excessive thirst Frequent urination Sores that heal slowly Excessive fatigue Gestational [thebump.com]

• Weakness

  Among women with possible GDM in both early and late periods of pregnancy, there was only weak diagnostic agreement between results determined with 75-g and 100-g glucose loads. [ncbi.nlm.nih.gov]

  A κ index of 0–0.2 suggested weak agreement, 0.2–0.4 fair agreement, 0.4–0.8 good agreement, and 0.8–1.0 perfect agreement; 0 values suggested disagreement( 6 ). [doi.org]

  If symptoms do occur, they may include: Increased urination Thirst Hunger Weakness Vaginal or urinary tract infections Testing for Gestational Diabetes As part of prenatal screening, your doctor will test you for gestational diabetes. [uvahealth.com]

  Return to The Medical Biochemistry Page © 1996–2019 themedicalbiochemistrypage.org, LLC | info @ themedicalbiochemistrypage.org Glanzmann thrombasthenia (weak platelets) is an autosomal recessive disorder that was originally described in 1918 by the Swiss [themedicalbiochemistrypage.org]

• Fishing

  Protein foods to avoid or limit are fatty meat and fish and seafood with high mercury levels, such as swordfish and king mackerel. A diet for gestational diabetes should consist of 35 percent to 40 percent fat. [livestrong.com]

  Lean protein You may be advised to choose lean (not fatty) proteins, such as fish. Eat two portions of fish a week, one of which should be oily fish, such as sardines or mackerel. [hse.ie]

  However, take caution with raw fish. Can I eat raw fish and sushi while pregnant? It’s best to avoid any foods that may have harmful bacteria such as salmonella and E. Coli. [ngala.com.au]

• Overeating

  The number of GDM women increased significantly each year over the course of the study, as did the proportion requiring insulin therapy. [ncbi.nlm.nih.gov]

  These factors increase your risk of developing diabetes during pregnancy: Being overweight before becoming pregnant (if you are 20% or more over your ideal body weight) Family history of diabetes (if your parents or siblings have diabetes) Being over [my.clevelandclinic.org]

  When the pregnancy is over and blood glucose levels return to normal the diabetes disappears, however this insulin resistance increases the risk of developing type 2 diabetes in later life. [diabetestas.org.au]

• Vomiting

  She suffered from severe headache, blurred vision, dizziness, and vomiting. Her baby was delivered by Cesarean section. The brain magnetic resonance images revealed pituitary necrosis. [ncbi.nlm.nih.gov]

  […] dysplasia, cervix 654.6 early onset of delivery (spontaneous) 644.2 eclampsia, eclamptic (coma) (convulsions) (delirium) (nephritis) (uremia) 642.6 edema 646.1 effusion, amniotic fluid 658.1 embolism emesis (gravidarum) - see Pregnancy, complicated, vomiting [icd9data.com]

  You should use these if your blood glucose levels are high, or if you are vomiting or have diarrhoea. [nhs.uk]

  All women should test urine for ketones if blood glucose is high, if vomiting occurs or if they are unwell. [diabetes.co.uk]

• Hypertension

  Hypertensive disorders in pregnant women with diabetes mellitus. Gynecol Obstet Invest 1997, 44 :11–15. PubMed CrossRef Google Scholar 21. [doi.org]

  Evidence quality for two comparisons was assessed using GRADE, for primary outcomes for the mother: hypertensive disorders of pregnancy; caesarean section; type 2 diabetes mellitus; and child: large-for-gestational age; perinatal mortality; neonatal mortality [ncbi.nlm.nih.gov]

• Blurred Vision

  She suffered from severe headache, blurred vision, dizziness, and vomiting. Her baby was delivered by Cesarean section. The brain magnetic resonance images revealed pituitary necrosis. [ncbi.nlm.nih.gov]

  Women may experience blurred vision, fatigue, vaginal infections, increased thirst, frequent urination, and nausea. Blood sugar levels will usually return to normal levels after delivery. [virtua.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]

  Signs and symptoms can include: Sugar in urine (revealed in a test done in your doctor’s office) Unusual thirst Frequent urination Fatigue Nausea Frequent vaginal, bladder, and skin infections Blurred vision Who gets gestational diabetes, and why do I [americanpregnancy.org]

  Here are some possible signs of gestational diabetes that should be brought to your doctor’s attention: Blurred vision Tingling or numbness in the hands and/or feet Excessive thirst Frequent urination Sores that heal slowly Excessive fatigue Gestational [thebump.com]

• Cesarean Section

  In two-step method, higher pre-pregnancy body mass index and lower physical activity during pregnancy along with higher earlier cesarean section also increased significantly the risk of developing GDM. [ncbi.nlm.nih.gov]

GDM has a number of guidelines for screening and diagnosing, with striking heterogeneity between the different recommendations. The recommendations from the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) have been endorsed by a number of professional bodies [8].

The recommendations put forth by IADPSG suggest universal screening for GDM. Pregnant women need to be screened at the first antenatal visit with the standard criteria used in the non-pregnant state i.e. a diagnosis of GDM is made by fasting plasma glucose (FPG) level ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), or HbA1c (glycosylated hemoglobin) ≥ 6.5%. The aim of screening at this time is to diagnose women with pre-existing diabetes.

If the results at this stage are negative, screening needs to be repeated at 24-28 weeks of gestation with the use of oral glucose tolerance test (OGTT). The following cut off values in the OGTT point towards the diagnosis of GDM: FPG (5.1 mmol/l [92 mg/dl]), one hour plasma glucose (10 mmol/l [180 mg/dl]), and two hour plasma glucose (8.5 mmol/l [153 mg/dl]). These cut off values have been endorsed by the World Health Organization (WHO).

Following the diagnosis of GDM, there are other associated tests that need to be performed in each trimester to identify risks to the mother or child. Regular blood glucose testing needs to be done, either with HbA1c testing or capillary blood glucose.

Important tests in the first and second trimester are spot urine protein to creatinine ratio and ultrasonography (US). US in the first trimester is important for dating and establishing viability while a second trimester US is essential for assessing anatomical abnormalities. Furthermore, US remains important in the third trimester to assess fetal growth.

• Glycosuria

  False-negative test stick measurements can appear in patients with low glycosuria. The rate of glycosuria shows high individual differences and dependent on the concentration of vitamin C. [ncbi.nlm.nih.gov]

  […] detected by routine antenatal testing be aware that glycosuria of 2+ or above on 1 occasion or of 1+ or above on 2 or more occasions detected by reagent strip testing during routine antenatal care may indicate undiagnosed gestational diabetes. [gpnotebook.co.uk]

  Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo glucose testing (see below) as soon as feasible. [care.diabetesjournals.org]

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

However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of GDM improves perinatal outcome. [ncbi.nlm.nih.gov]

In spite of poor prognosis, the child was born at the 39th gestation week in a good condition. [ncbi.nlm.nih.gov]

Prognosis Women with gestational diabetes tend to have larger babies and increased problems during delivery. Many times a C-Section is needed to avoid further complications during the birthing process. [virtua.org]

[…] thrombasthenia: Genetic and Rare Diseases Information Center (GARD) -- rarediseases.info.nih.gov/diseases/2478/glanzmann-thrombasthenia National Organization for Rare Disorders (NORD) -- rarediseases.org/rare-diseases/glanzmann-thrombasthenia Outlook (Prognosis [ufhealth.org]

Early diagnosis and prompt treatment carry good prognosis. Communities should be counseled to avoid consanguineous marriage and related hazards. [jiaomr.in]

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]

In some patient populations, it may represent an often overlooked etiologic or exacerbating factor in the condition of gestational diabetes. [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]

Author information 1 Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China. 2 Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China [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]

Data presented tie in insights with underlying pathophysiologic processes leading to GDM. Screening and diagnostic thresholds are discussed along with management upon diagnosis. [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]

Women who don't have diabetes should be advised about their risk and participate in family planning to prevent subsequent pregnancies with undiagnosed hyperglycemia. [ncbi.nlm.nih.gov]

True effectiveness of specific structured exercise programs remains untapped in GDM prevention and treatment and many well-controlled exercise studies are warranted. [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]

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