Gestational diabetes mellitus: state of art
https://doi.org/10.21518/ms2023-112
Abstract
Gestational diabetes mellitus (GDM) is a disease characterized by hyperglycemia, first established during pregnancy, while the concentration of venous plasma glucose should not exceed 6.9 mmol/l. As a rule, after childbirth, the disease regresses, but it does not pass without a trace for either the mother or the child. The consequences of gestational diabetes include an increased risk of cardiovascular diseases in the mother and type 2 diabetes, as well as diabetic fetopathy of the fetus and complications during pregnancy and childbirth: the threat of termination of pregnancy, premature birth, preeclampsia, polyhydramnios, high frequency of operative delivery and birth trauma. There is also a long-term risk of developing obesity, diabetes and cardiovascular diseases in a child. Gestational diabetes affects approximately 16.5% of pregnant women worldwide, an increase in the incidence is predicted due to an increase in the percentage of obese women. Gestational diabetes mellitus is a complication of gestation that is not easily diagnosed and poorly predicted, and therefore potentially threatening to any pregnancy, requiring, given the list of perinatal and long – term consequences for mother and child, pre-gravidar prevention, thorough diagnosis and mandatory treatment with permanent control of glycemia levels, ketonuria and instrumental monitoring: cardiotcography and ultrasound. A competent approach to pregnancy planning, the implementation of a screening program for GDM and timely correction in case of its detection is the key to the health of a woman and her unborn child.
About the Authors
S. A. Pletneva
Voronezh State Medical University named after N.N. Burdenko
Russian Federation
Russian Federation
Swetlana A. Pletneva, Postgraduate Student of the Department of Obstetrics and Gynecology No. 2,
10, Studencheskaya St., Voronezh, 394036
E. V. Enkova
Voronezh State Medical University named after N.N. Burdenko
Russian Federation
Russian Federation
Elena V. Enkova, Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology No. 2,
10, Studencheskaya St., Voronezh, 394036
O. V. Khoperskaya
Voronezh State Medical University named after N.N. Burdenko
Russian Federation
Russian Federation
Olga V. Khoperskaya, Cand. Sci. (Med.), Assistant of the Department of Obstetrics and Gynecology No. 2,
10, Studencheskaya St., Voronezh, 394036
S. V. Shamarin
Voronezh State Medical University named after N.N. Burdenko
Russian Federation
Russian Federation
Stanislav V. Shamarin, Cand. Sci. (Med.), Associate Professor of the Department of Obstetrics and Gynecology No. 2,
10, Studencheskaya St., Voronezh, 394036
V. V. Enkova
Voronezh State Medical University named after N.N. Burdenko
Russian Federation
Russian Federation
Valeria V. Enkova, Cand. Sci. (Med.), Assistant of the Department of Obstetrics and Gynecology No. 2,
10, Studencheskaya St., Voronezh, 394036
References
1. Medici Dualib P., Ogassavara J., Mattar R., Mariko Koga da Silva E., Atala Dib S., de Almeida Pititto B. Gut microbiota and gestational Diabetes Mellitus: A systematic review. Diabetes Res Clin Pract. 2021;180:109078. https://doi.org/10.1016/j.diabres.2021.109078.
2. Chiefari E., Arcidiacono B., Foti D., Brunetti A. Gestational diabetes mellitus: An updated overview. J Endocrinol. Investig. 2017;40:899–909. https://doi.org/10.1007/s40618-016-0607-5.
3. American Diabetes Association Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes – 2018. Diabetes Care. 2018;41(1 Suppl.):13–27. https://doi.org/10.2337/dc18-S002.
4. Zajdenverg L., Negrato C.A. Gestational diabetes mellitus and type 2 diabetes: Same disease in a different moment of life? Maybe not. Arch Endocrinol Metab. 2017;61:208–210. https://doi.org/10.1590/2359-3997000000276.
5. Gascho C.L., Leandro D.M., Ribeiro E. Silva T., Silva J.C. Predictors of cesarean delivery in pregnant women with gestational diabetes mellitus. Rev Bras Ginecol Obstet. 2017;39(2):60–65. https://doi.org/10.1055/s-0037-1598644.
6. Tam W.H., Ma R.C.W., Ozaki R., Li A.M., Chan M.H.M., Yuen L.Y. In Utero Exposure to Maternal Hyperglycemia Increases Childhood Cardiometabolic Risk in Offspring. Diabetes Care. 2017;40(5):679–686. https://doi.org/10.2337/dc16-2397.
7. Lesseur C., Chen J. Adverse Maternal Metabolic Intrauterine Environment and Placental Epigenetics: Implications for Fetal Metabolic Programming. Curr Environ Health Rep. 2018;5(4):531–543. https://doi.org/10.1007/s40572-018-0217-9.
8. Li J., Song L., Zhou L., Wu J., Sheng C., Chen H. et al. A MicroRNA Signature in Gestational Diabetes Mellitus Associated with Risk of Macrosomia. Cell Physiol Biochem. 2015;37(1):243–252. https://doi.org/10.1159/000430349.
9. Zhu Y., Zhang C. Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: A Global Perspective. Curr Diabetes Rep. 2016;16:7–21. https://doi.org/10.1007/s11892-015-0699-x.
10. Capula C., Chiefari E., Vero A., Arcidiacono B., Iiritano S., Puccio L. et al. Gestational diabetes mellitus: screening and outcomes in southern italian pregnant women. ISRN Endocrinol. 2013;2013:387495. https://doi.org/10.1155/2013/387495.
11. Shostrom D.C.V., Sun Y., Oleson J.J., Snetselaar L.G., Bao W. History of Gestational Diabetes Mellitus in Relation to Cardiovascular Disease and Cardiovascular Risk Factors in US Women. Front Endocrinol. 2017;8:144. https://doi.org/10.3389/fendo.2017.00144.
12. Helle E., Priest J.R. Maternal Obesity and Diabetes Mellitus as Risk Factors for Congenital Heart Disease in the Offspring. J Am Heart Assoc. 2020;9(8):e011541. https://doi.org/10.1161/JAHA.119.011541.
13. Saravanan P., Diabetes in Pregnancy Working Group, Maternal Medicine Clinical Study Group et al. Gestational diabetes: opportunities for improving maternal and child health. Lancet Diabetes Endocrinol. 2020;8(9):793–800. https://doi.org/10.1016/S2213-8587(20)30161-3.
14. Mohsin F., Khan S., Baki M.A., Zabeen B., Azad K. Neonatal management of pregnancy complicated by diabetes. J Pak Med Assoc. 2016;66(9):81–94. Available at: https://pubmed.ncbi.nlm.nih.gov/27582162.
15. Moon J.H., Jang H.C. Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications. Diabetes Metab J. 2022;46(1):3–14. https://doi.org/10.4093/dmj.2021.0335.
16. Choi M.J., Yu J., Choi J. Maternal Pre-Pregnancy Obesity and Gestational Diabetes Mellitus Increase the Risk of Childhood Obesity. Children (Basel). 2022;9(7):928. https://doi.org/10.3390/children9070928.
17. Teshome A.A., Li Q., Garoma W., Chen X., Wu M., Zhang Y. et al. Gestational diabetes mellitus, pre-pregnancy body mass index and gestational weight gain predicts fetal growth and neonatal outcomes. Clin Nutr ESPEN. 2021;42:307–312. https://doi.org/10.1016/j.clnesp.2021.01.016.
18. Zheng W., Huang W., Liu C., Yan Q., Zhang L., Tian Z. et al. Weight gain after diagnosis of gestational diabetes mellitus and its association with adverse pregnancy outcomes: a cohort study. BMC Pregnancy Childbirth. 2021;21(1):216. https://doi.org/10.1186/s12884-021-03690-z.
19. Shi P., Liu A., Yin X. Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):508. https://doi.org/10.1186/s12884-021-03982-4.
20. Plows J.F., Stanley J.L., Baker P.N., Reynolds C.M., Vickers M.H. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018;19(11):3342. https://doi.org/10.3390/ijms19113342.
21. Bennewitz H. De diabete mellito, graviditatis symptomate. University of Berlin; 1824, pp. 24–29.
22. Metzger B.E., Lowe L.P., Dyer A.R., Trimble E.R., Chaovarindr U., Coustan D.R. et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002. https://doi.org/10.1056/NEJMoa0707943.
23. Dedov I.I., Krasnopol’skiĭ V.I., Sukhikh G.T. The Project of Russian Consensus “Gestational diabetes mellitus: diagnostics, treatment, postpartum follow-up”. Problems of Endocrinology.2013;59(1):23–29. (In Russ.) https://doi.org/10.14341/probl201359123-29.
24. Facco F.L., Grobman W.A., Reid K.J., Parker C.B., Hunter S.M., Silver R.M. et al. Objectively measured short sleep duration and later sleep midpoint in pregnancy are associated with a higher risk of gestational diabetes. Am J Obstet Gynecol. 2017;217(4):447.e1-447.e13. https://doi.org/10.1016/j.ajog.2017.05.066.
25. Mijatovic-Vukas J., Capling L., Cheng S., Stamatakis E., Louie J., Cheung N.W. et al. Associations of Diet and Physical Activity with Risk for Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Nutrients. 2018;10(6):698. https://doi.org/10.3390/nu10060698.
26. Rasmussen L., Poulsen C.W., Kampmann U., Smedegaard S.B., Ovesen P.G., Fuglsang J. Diet and Healthy Lifestyle in the Management of Gestational Diabetes Mellitus. Nutrients. 2020;12(10):3050. https://doi.org/10.3390/nu12103050.
27. Yamamoto J.M., Kellett J.E., Balsells M., García-Patterson A., Hadar E., Solà I. et al. Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight. Diabetes Care. 2018;41(7):1346–1361. https://doi.org/10.2337/dc18-0102.
28. Laredo-Aguilera J.A., Gallardo-Bravo M., Rabanales-Sotos J.A., Cobo-Cuenca A.I., Carmona-Torres J.M. Physical Activity Programs during Pregnancy Are Effective for the Control of Gestational Diabetes Mellitus. Int J Environ Res Public Health. 2020; 17(17):6151. https://doi.org/10.3390/ijerph17176151.
29. Teshome A.A., Li Q., Garoma W., Chen X., Wu M., Zhang Y. et al. Gestational diabetes mellitus, pre-pregnancy body mass index and gestational weight gain predicts fetal growth and neonatal outcomes. Clin Nutr ESPEN. 2021;42:307–312. https://doi.org/10.1016/j.clnesp.2021.01.016.
30. Cai S., Tan S., Gluckman P.D., Godfrey K.M., Saw S.M., Teoh O.H. et al. Sleep Quality and Nocturnal Sleep Duration in Pregnancy and Risk of Gestational Diabetes Mellitus. Sleep. 2017;40(2). https://doi.org/10.1093/sleep/zsw058.
31. Rold L.S., Bundgaard-Nielsen C., Niemann H.-J.J., Glud Ovesen P., Leutscher P., Hagstrøm S., Sørensen S. Characteristics of the gut microbiome in women with gestational diabetes mellitus: A systematic review. PLoS ONE. 2022;17(1):e0262618. https://doi.org/10.1371/journal.pone.0262618.
32. Hasain Z., Mokhtar N.M., Kamaruddin N.A., Mohamed Ismail N.A., Razalli N.H., Gnanou J.V. et al. Gut Microbiota and Gestational Diabetes Mellitus: A Review of Host-Gut Microbiota Interactions and Their Therapeutic Potential. Front Cell Infect Microbiol. 2020;10:188. https://doi.org/10.3389/fcimb.2020.00188.
33. Hawkins J.S., Casey B.M., Lo J.Y., Moss K., McIntire D.D., Leveno K.J. Weekly compared with daily blood glucose monitoring in women with diet-treated gestational diabetes. Obstet Gynecol. 2009;113(6):1307–1312. https://doi.org/10.1097/AOG.0b013e3181a45a93.
34. Kautzky-Willer A., Harreiter J., Winhofer-Stöckl Y., Bancher-Todesca D., Berger A., Repa A. et al. Gestationsdiabetes (GDM) (Update 2019) [Gestational diabetes mellitus (Update 2019)]. Wien Klin Wochenschr. 2019;131(Suppl. 1):91–102. (In German.) https://doi.org/10.1007/s00508-018-1419-8.
35. Selvin E. Measurements of glycemia in diabetes mellitus. UpToDate. 2022. Available at: https://www.uptodate.com/contents/1807.
36. Weinstock R.S. General principles of insulin therapy in diabetes mellitus. UpToDate. 2022. Available at: https://www.uptodate.com/contents/generalprinciples-of-insulin-therapy-in-diabetes-mellitus.
37. Ye W., Luo C., Huang J., Li C., Liu Z., Liu F. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2022;377:e067946. https://doi.org/10.1136/bmj-2021-067946.
38. McIntyre H.D., Catalano P., Zhang C., Desoye G., Mathiesen E.R., Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019;5(1):47. https://doi.org/10.1038/s41572-019-0098-8.
39. Care D. Standards of Medical Care in Diabetes 2019. Diabetes Care. 2019;42:81. Available at: https://fmdiabetes.org/wp-content/uploads/2019/01/ada-2019.pdf.
40. Chatzakis C., Cavoretto P., Sotiriadis A. Gestational Diabetes Mellitus Pharmacological Prevention and Treatment. Curr Pharm Des. 2021;27(36):3833–3840. https://doi.org/10.2174/1381612827666210125155428.
41. Sacks D.A. Etiology, detection, and management of fetal macrosomia in pregnancies complicated by diabetes mellitus. Clin Obstet Gynecol. 2007;50(4):980–989. https://doi.org/10.1097/GRF.0b013e31815a6242.
42. Schäfer-Graf U.M., Wöckel A. Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, 12351 Berlin. ute.schaefer-graf@vivantes.d [Severe diabetic fetopathy due to undiagnosed gestational diabetes mellitus]. Dtsch Med Wochenschr. 2006;131(20):1151–1154. (In German.) https://doi.org/10.1055/s-2006-941742.
43. Burumkulova F.F., Troitskaya M.V., Petrukhin V.A., Bashakin N.F., Aksenov A.N., Kotov Yu.B. Diabetic fetopathy and perinatal pathology in pregnancy complicated by gestational diabetes mellitus. Disease Treatment and Prevention. 2013;(2):125–132. (In Russ.) Available at: https://elib.fesmu.ru/elib/Article.aspx?id=298850.
44. Haneda M., Noda M., Origasa H., Noto H., Yabe D., Fujita Y. et al. Japanese Clinical Practice Guideline for Diabetes 2016. J Diabetes Investig. 2018;9(1):657–697. https://doi.org/10.1111/jdi.12810.
45. Andreeva E.N., Arbatskaya N.Yu., Arzhanova O.N., Bashmakova N.V., Borovik N.V., Burumkulova F.F. et al. Gestational diabetes. Diagnosis, treatment, obstetric tactics, postpartum care: clinical guidelines. 2020. 53p. (In Russ.) Available at: https://agsd.ru/dokumenti/35-acticle14-08-2020.
46. Beta J., Khan N., Khalil A., Fiolna M., Ramadan G., Akolekar R. Maternal and neonatal complications of fetal macrosomia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2019;54(3):308–318. https://doi.org/10.1002/uog.20279.
Review
For citations:
Pletneva SA, Enkova EV, Khoperskaya OV, Shamarin SV, Enkova VV. Gestational diabetes mellitus: state of art. Meditsinskiy sovet = Medical Council. 2023;(5):136-141. (In Russ.) https://doi.org/10.21518/ms2023-112
Views:
568
Email this article 