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Gestational diabetes mellitus

Nature Reviews Disease Primers volume 5, Article number: 47 (2019) Cite this article

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Abstract

Hyperglycaemia that develops during pregnancy and resolves after birth has been recognized for over 50 years, but uniform worldwide consensus is lacking about threshold hyperglycaemic levels that merit a diagnosis of ‘gestational diabetes mellitus’ (GDM) and thus treatment during pregnancy. GDM is currently the most common medical complication of pregnancy, and prevalence of undiagnosed hyperglycaemia and even overt diabetes in young women is increasing. Maternal overweight and obesity, later age at childbearing, previous history of GDM, family history of type 2 diabetes mellitus and ethnicity are major GDM risk factors. Diagnosis is usually performed using an oral glucose tolerance test (OGTT), although a non-fasting, glucose challenge test (GCT) is used in some parts of the world to screen women for those requiring a full OGTT. Dietary modification and increased physical activity are the primary treatments for GDM, but pharmacotherapy, usually insulin, is used when normoglycaemia is not achieved. Oral hypoglycaemic agents, principally metformin and glibenclamide (glyburide), are also used in some countries. Treatment improves immediate pregnancy outcomes, reducing excess fetal growth and adiposity and pregnancy-related hypertensive disorders. GDM increases the risk of long-term complications, including obesity, impaired glucose metabolism and cardiovascular disease, in both the mother and infant. Optimal management of mother and infant during long-term follow-up remains challenging, with very limited implementation of preventive strategies in most parts of the world.

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Fig. 1: Global prevalence of GDM in 2005–2018.
Fig. 2: Country-specific prevalence of GDM according to different diagnostic criteria.
Fig. 3: Pathophysiology of GDM.
Fig. 4: Pregnancy as a metabolic stress test for future metabolic disorders.
Fig. 5: Changes in insulin sensitivity during pregnancy in normoglycaemic women and women with GDM.
Fig. 6: Insulin sensitivity–secretion relationships in normoglycaemic women and women with GDM.
Fig. 7: Changes in insulin signalling in normoglycaemic and GDM pregnancies.
Fig. 8: Pathophysiology of fetal phenotype in GDM.
Fig. 9: Application of the DOHAD hypothesis to GDM.

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Acknowledgements

C.Z. is supported by the intramural research program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH.

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Authors and Affiliations

  1. Mater Research and University of Queensland, Brisbane, Queensland, Australia

    H. David McIntyre

  2. Mother Infant Research Institute, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Friedman School of Nutrition Science and Policy, Boston, MA, USA

    Patrick Catalano

  3. Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA

    Cuilin Zhang

  4. Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria

    Gernot Desoye

  5. Department of Endocrinology, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Elisabeth R. Mathiesen

  6. Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet and The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Peter Damm

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  1. H. David McIntyre
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  2. Patrick Catalano
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  3. Cuilin Zhang
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  4. Gernot Desoye
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  5. Elisabeth R. Mathiesen
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  6. Peter Damm
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Contributions

Introduction (H.D.M.); Epidemiology (C.Z.); Mechanisms/pathophysiology (P.C. and G.D.); Diagnosis, screening and prevention (H.D.M., C.Z. and E.R.M.); Management (P.C. and E.R.M.); Quality of life (P.D.); Outlook (H.D.M., P.C., C.Z., G.D. and P.D.); Overview of the Primer (H.D.M.).

Corresponding author

Correspondence to H. David McIntyre.

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Competing interests

P.D. is participating in multi-centre and multinational clinical studies on the use of insulin in pregnant women with pre-existing diabetes in collaboration with Novo Nordisk; no personal honorarium is involved. E.R.M. is participating in multinational clinical studies on the use of insulin in pregnant women with pre-existing diabetes in collaboration with Novo Nordisk. E.R.M. has given talks for Novo Nordisk, AstraZeneca, Lilly and Sanofi Aventis and has received a salary for these tasks. H.D.M., C.Z., P.C. and G.D. declare no competing interests.

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Nature Reviews Disease Primers thanks D. Coustan, T. Buchanan and L. Sobrevia for their contribution to the peer review of this work.

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McIntyre, H.D., Catalano, P., Zhang, C. et al. Gestational diabetes mellitus. Nat Rev Dis Primers 5, 47 (2019). https://doi.org/10.1038/s41572-019-0098-8

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