Agarwal MM. Gestational diabetes mellitus: an update on the current international diagnostic criteria. World J Diabetes. 2015; 6:(6)782-91

Al-Badri MR, Zantout MS, Azar ST. The role of adipokines in gestational diabetes mellitus. Ther Adv Endocrinol Metab. 2015; 6:(3)103-8

Practice bulletin no. 180: gestational diabetes mellitus. Obst Gynecol. 2017; 130:(1)e17-e37

Classification and diagnosis of diabetes. Diabetes Care. 2017; 40:(1)S11-24

Baz B, Riveline J, Gautier J. Endocrinology of pregnancy: gestational diabetes mellitus: definition, aetiological and clinical aspects. Eur J Endocrinol. 2016; 174:(2)R43-51

Bilous R. Diagnosis of gestational diabetes, defining the net, refining the catch. Diabetologia. 2015; 58:(9)1965-8

Blackburn S. Maternal, Fetal, & Neonatal Physiology, 5th edn. Philadelphia, PA: Elsevier Saunders; 2017

Burlina S, Dalfrà MG, Lapolla A. Short- and long-term consequences for offspring exposed to maternal diabetes: a review. J Matern Fetal Neonatal Med. 2017; 1-8

Caissutti C, Berghella V. Scientific evidence for different options for GDM screening and management: controversies and review of the literature. BioMed Res Int. 2017; 1-12

Catalano P, De Mouzon SH. Maternal obesity and metabolic risk to the offspring: why lifestyle interventions may have not achieved the desired outcomes. Int J Obesity. 2015; 39:(4)642-9

Crandall J, Shamoon H. Diabetes mellitus, 25th edn. Philadelphia, PA: Elsevier Saunders; 2015

Gabbay-Benziv R, Baschat AA. Gestational diabetes as one of the “great obstetrical syndromes” – the maternal, placental, and fetal dialog. Best Pract Res Clin Obstet Gynaecol. 2015; 29:(2)150-5

Hod M, Kapur A, Sacks DA The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynecol Obstet. 2015; 131

Hunt KF, Whitelaw BC, Gayle C. Gestational diabetes. Obstet Gynaecol Reproduct Med. 2014; 24:(8)238-44

Kapur A, Mahmood T, Hod M. The unmet need for universal testing for hyperglycaemia in pregnancy and the FIGO guideline. BJOG. 2017;

Kapur A, Mahmood T, Hod M. FIGO's response to the global challenge of hyperglycemia in pregnancy – toward a global consensus. Gynecol Endocrinol. 2018; 34:(1)1-3

KC K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nut Metab. 2015; 66:(2)14-20

Lindsay RS, Mackin ST, Nelson SM. Gestational diabetes mellitus—right person, right treatment, right time?. BMC Medicine. 2017; 15:(1)

Meek CL, Lewis HB, Patient C, Murph HR, Simmons D. Diagnosis of gestational diabetes mellitus: falling through the net. Diabetologia. 2015; 58:(9)2003-12

Metzger B, Lowe L, Dyer A Hyperglycemia and Adverse Pregnancy Outcomes. N Eng J Med. 2008; 358:(19)1991-2002

Metzger BE, Gabbe SG, Persson B International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33:(3)676-82

Mirghani Dirar A, Doupis J. Gestational diabetes from A to Z. World J Diabetes. 2017; 8:(12)489-511

Mitanchez D, Yzydorczyk C, Siddeek B, Boubred F, Benahmed M, Simeoni U. The offspring of the diabetic mother – Short- and long-term implications. Best Prac Res Clin Obstet Gynaecol. 2015; 29:(2)256-69

Monteiro LJ, Norman JE, Rice GE, Illanes SE. Fetal programming and gestational diabetes mellitus. Placenta. 2016; 48:S54-S60

National Institute for Health and Clinical Excellence. Diabetes in pregnancy: management from preconception to the postnatal period [NG3]. 2015. (accessed 13 June 2018)

Phelan S. Windows of opportunity for lifestyle interventions to prevent gestational diabetes mellitus. Am J Perinatol. 2016; 33:(13)1291-99

Piper LK, Stewart Z, Murphy HR. Gestational diabetes. Obstet Gynaecol Reproduct Med. 2017; 27:(6)171-6

Powe CE, Allard C, Battista M Heterogeneous contribution of insulin sensitivity and secretion defects to gestational diabetes mellitus. Diabetes Care. 2016; 39:(6)1052-55

Rang HP, Ritter JM, Flower RJ, Henderson G. Rang & Dales Pharmacology, 8th edn. New York, NY: Elsevier; 2016

Rankin J. Physiology in Childbearing, 4th edn. New York, NY: Elsevier; 2017

Salmeen K. Gestational diabetes testing: making sense of the controversy. J Midwifery Womens Health. 2016; 61:(2)203-9

Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2017; 11

Stewart ZA, Murphy HR. Gestational diabetes. Medicine. 2015; 43:(1)44-7

Wang G, Bartell TR, Wang X. Preconception and prenatal factors and metabolic risk. In: Halfon N, Forrest C, Lerner R, Faustman E (eds). Cham: Springer; 2018

World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. 2013. (accessed 13 June 2018)

Zhang C, Rawal S, Chong YS. Risk factors for gestational diabetes: is prevention possible?. Diabetologia. 2016; 59:(7)1385-90

Gestational diabetes

02 August 2018
15 min read
Volume 26 · Issue 8


Gestational diabetes affects 5-7% of all pregnancies and has an effect on care during pregnancy, as well as on outcomes for both mother and fetus. Its prevalence is rising, along with the background prevalence of obesity and type 2 diabetes. This is not surprising, considering that they are intertwined in a cycle whereby having one condition increases the risk of having the other, and that they can all be passed down through the generations. This article will discuss the pathophysiology of gestational diabetes, as well as methods of screening, diagnosis, and intervention; increased knowledge and optimisation of which have the potential to slow the amplifying intergenerational cycle of these conditions.

Diabetes mellitus is an endocrine disorder in which insulin production or action is insufficient, resulting in hyperglycaemia. Insulin is produced in pancreatic beta (b) cells and is required for the uptake of glucose into cells, as well as the storage of glycogen, protein and fats. Thus, insufficient insulin action results in hyperglycaemia, and the breakdown of storage forms of fuel (glycogen, fats, and proteins) for use by the body's cells, due to lack of availability of glucose. There are three main types of diabetes (Table 1): type 1 diabetes is characterised by early age of onset, destruction of pancreatic b cells, and the need for therapeutic insulin. Type 2 is characterised by older age of onset, insulin resistance and insufficient insulin production to variable degrees, and is associated with obesity and a sedentary lifestyle. Gestational diabetes mellitus is seen only in pregnancy, typically in the third trimester, and it is thought to result from the metabolic changes brought on by pregnancy, along with an underlying predisposition to developing this condition (Crandall and Shamoon, 2015; American Diabetes Association (ADA), 2017; Rankin, 2017). This article will discuss the aetiology of gestational diabetes, how it is identified in pregnancy and controversies around this, adverse effects associated with it for the mother, fetus and child, and interventions aimed at preventing its development as well the associated adverse outcomes.

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