References
Gestational diabetes mellitus: ensuring healthy futures
Abstract
Gestational diabetes mellitus is the most common medical condition in pregnancy, disproportionately affecting overweight or obese women and those from non-White populations. The lack of standardised screening and diagnostic consensus contributes to varying prevalence. Conventional risk factor-based screening can leave women undiagnosed, leading to increased risk of harm. If diet and lifestyle modifications fail to achieve glycaemic targets, prompt treatment should be initiated to manage glucose levels. A planned birth is crucial to ensure the best outcomes. Postpartum, women need screening for type 2 diabetes and other cardiometabolic risk factors, enrollment in diabetes prevention programmes, and counselling on the increased risk of future cardiometabolic disease for themselves and their offspring, highlighting the importance of ongoing prevention and management strategies.
Gestational diabetes mellitus is defined as diabetes with first onset or recognition during pregnancy (Skajaa et al, 2020). It is typically identified during the second or third trimester of pregnancy, representing insufficient insulin production or increased insulin resistance secondary to placental hormone release, with resolution following birth (Skajaa et al, 2020).
A 60% reduction in insulin sensitivity is seen in all pregnancies (Catalano, 2014), typically after approximately 20 weeks' gestation (Kampmann et al, 2019). Reduced peripheral insulin sensitivity causes reduced insulin-stimulated glucose uptake in skeletal muscle. In combination with reduced hepatic suppression of glucose production in response to insulin and an inability of pancreatic beta cells to meet the increased insulin demands during pregnancy, gestational diabetes mellitus is clinically apparent in the development of hyperglycaemia (Catalano, 2014). In line with the timing of these hormonal changes, screening for gestational diabetes mellitus occurs at 24–28 weeks, although this can occur earlier in women considered at increased risk (Diabetes UK, 2023).
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