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].

• Increased Energy

  In general, there is not an increased energy requirement during the first trimester of pregnancy. [doi.org]

• Pharyngitis

  DESIGN: Pregnant women and neonates suffering from GDM were enrolled and 581 maternal (oral, intestinal and vaginal) and 248 neonatal (oral, pharyngeal, meconium and amniotic fluid) samples were collected. [ncbi.nlm.nih.gov]

• Diastolic Hypertension

  To evaluate the prevalence of MS in the cohort on the basis of the conventional criteria established by NCEP, we examined the proportion of subjects 6 to 11 years of age in each of the 4 groups with 1 component (obesity, systolic or diastolic hypertension [doi.org]

• Third Trimester Bleeding

  Aerobic exercise during pregnancy is contraindicated in a number of medical conditions, including: cardiac disease; restrictive lung disease; incompetent cervix/cerclage; multiple gestation at risk of preterm birth; persistent second or third trimester [doi.org]

• Short Legs

  Although short leg length is an independent predictor of GDM in the Chinese, this was less significant than other factors such as age and weight gain, while in the nonpregnant Hong Kong Chinese population, BMI, waist-to-hip ratio, waist circumference, [doi.org]

• 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]

  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]

  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]

  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]

  Blurred vision. Pregnancy causes most women to urinate more often and to feel more hungry. So having these symptoms doesn't always mean that a woman has diabetes. [myhealth.alberta.ca]

• Incontinence

  Benefits observed include cardio‐respiratory fitness, prevention of stress urinary incontinence, prevention of lumbar pain, decreased depression and control of weight gain during pregnancy ( Nascimento 2012 ). [doi.org]

• Urinary Incontinence

  Benefits observed include cardio‐respiratory fitness, prevention of stress urinary incontinence, prevention of lumbar pain, decreased depression and control of weight gain during pregnancy ( Nascimento 2012 ). [doi.org]

• Learning Difficulties

  difficulties, and possibly autism spectrum disorder (ASD)) ( Gardener 2009 ; Krakowiak 2012 ; Nomura 2012 ; Ornoy 2015 ). [doi.org]

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.

• Progesterone Increased

  Early in pregnancy, maternal estrogen and progesterone increase and promote pancreatic ß-cell hyperplasia and increased insulin release. 13 Increases in peripheral glucose utilization and glycogen storage with a concomitant reduction in hepatic glucose [journal.diabetes.org]

• HLA-DR3

  Typical of autoimmune diabetes, the autoantibody-positive women had a normal BMI and an increased prevalence of HLA DR3 or DR4-DQ8 haplotypes, and the majority required insulin to treat their diabetes during pregnancy. [doi.org]

1. Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.
2. Berkowitz GS, Lapinski RH, Wein R, Lee D. Race/ethnicity and other risk factors for gestational diabetes. Am J Epidemiol. 1992;135:965–973.
3. Cypryk K, Szymczak W, Czupryniak L, Sobczak M, Lewiński A. Gestational diabetes mellitus - an analysis of risk factors. Endokrynol Pol. 2008;59:393–397.
4. Callesen NF, Ringholm L, Stage E, Damm P, Mathiesen ER. Insulin requirements in type 1 diabetic pregnancy: do twin pregnant women require twice as much insulin as singleton pregnant women? Diabetes Care. 2012;35:1246–1248.
5. Retnakaran R, Hanley AJ, Connelly PW, Sermer M, Zinman B. Ethnicity modifies the effect of obesity on insulin resistance in pregnancy: a comparison of Asian, South Asian, and Caucasian women. J Clin Endocrinol Metab. 2006;91:93–97.
6. World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014;103:341–363.
7. O’Sullivan JB, Charles D, Mahan CM, Dandrow RV. Gestational diabetes and perinatal mortality rate. Am J Obstet Gynecol. 1973;116:901–904.
8. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–682.