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10-03-2017 | Gestational diabetes | Review | Article

Gestational diabetes mellitus: an updated overview

Journal: Journal of Endocrinological Investigation

Authors: E. Chiefari, B. Arcidiacono, D. Foti, A. Brunetti

Publisher: Springer International Publishing

Abstract

The clinical and public health relevance of gestational diabetes mellitus (GDM) is widely debated due to its increasing incidence, the resulting negative economic impact, and the potential for severe GDM-related pregnancy complications. Also, effective prevention strategies in this area are still lacking, and controversies exist regarding diagnosis and management of this form of diabetes. Different diagnostic criteria are currently adopted worldwide, while recommendations for diet, physical activity, healthy weight, and use of oral hypoglycemic drugs are not always uniform. In the present review, we provide an update of current insights on clinical aspects of GDM, by discussing the more controversial issues.
Literature
1.
American Diabetes Association (2016) Classification and diagnosis of diabetes. Diabetes Care. doi:10.​2337/​dc16-S005
2.
Zhu Y, Zhang C (2016) Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. doi:10.​1007/​s11892-015-0699-x PubMed
3.
HAPO Study Cooperative Research Group et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Eng J Med. doi:10.​1056/​NEJMoa0707943
4.
Bellamy L et al (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. doi:10.​1016/​S0140-6736(09)60731-5
5.
Sullivan SD et al (2012) Gestational diabetes: implications for cardiovascular health. Curr Diab Rep. doi:10.​1007/​s11892-011-0238-3 PubMed
6.
HAPO Study Cooperative Research Group (2002) The hyperglycemia and adverse pregnancy outcome (HAPO) study. Int J Gynecology Obstetrics 78:69–77CrossRef
7.
Yuen L, Wong VW (2015) Gestational diabetes mellitus: challenges for different ethnic groups. World J Diabetes. doi:10.​4239/​wjd.​v6.​i8.​1024 PubMedPubMedCentral
8.
Moses RG et al (2016) Seasonal changes in the prevalence of gestational Diabetes Mellitus. Diabetes Care. doi:10.​2337/​dc16-0451 PubMedCentral
9.
International Association of Diabetes And Pregnancy Study Groups Consensus Panel International Association of Diabetes and Pregnancy Study Groups (2010) Recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. doi:10.​2337/​dc09-1848 PubMedCentral
10.
Huhn EA et al (2016) Fourfold increase in prevalence of gestational diabetes mellitus after adoption of the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. J Perinat Med. doi:10.​1515/​jpm-2016-0099
11.
Capula C et al (2013) Gestational Diabetes Mellitus: screening and outcomes in Southern Italian pregnant WOMEN. ISRN Endocrinol. doi:10.​1155/​2013/​387495
12.
Gopalakrishnan V et al (2015) Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria. J Postgrad Med. doi:10.​4103/​0022-3859.​159306 PubMedPubMedCentral
13.
Di Cianni G et al (2003) Intermediate metabolism in normal pregnancy and in gestational diabetes. Diabetes Metab Res Rev 19:259–270CrossRefPubMed
14.
Aune D et al (2016) Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose–response meta-analysis of epidemiological studies. Eur J Epidemiol 31:967–997CrossRefPubMedPubMedCentral
15.
Buchanan TA et al (2012) Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol. doi:10.​1038/​nrendo.​2012.​96 PubMedPubMedCentral
16.
Kim C et al (2007) Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care 30:1314–1319CrossRefPubMed
17.
Zhang C et al (2013) Genetic variants and the risk of gestational diabetes mellitus: a systematic review. Hum Reprod Update. doi:10.​1093/​humupd/​dmt013 PubMedCentral
18.
Brunetti A et al (2014) Recent advances in the molecular genetics of type 2 diabetes mellitus. World. J Diabetes. doi:10.​4239/​wjd.​v5.​i2.​128
19.
Wu L et al (2016) Genetic variants associated with gestational diabetes mellitus: a meta-analysis and subgroup analysis. Sci Rep. doi:10.​1038/​srep30539
20.
Pagán A et al (2014) A gene variant in the transcription factor 7-like 2 (TCF7L2) is associated with an increased risk of gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol. doi:10.​1016/​j.​ejogrb.​2014.​06.​024 PubMed
21.
Lin PC et al (2016) Transcription factor 7-Like 2 (TCF7L2) rs7903146 Polymorphism as a risk factor for gestational Diabetes Mellitus: a meta-analysis. PLoS One. doi:10.​1371/​journal.​pone.​0153044
22.
Kwak SH et al (2012) A genome-wide association study of gestational diabetes mellitus in Korean women. Diabetes. doi:10.​2337/​db11-1034 PubMedPubMedCentral
23.
Kanthimathi S et al (2016) Hexokinase domain containing 1 (HKDC1) gene variants and their association with gestational Diabetes Mellitus in a South Indian population. Ann Hum Genet. doi:10.​1111/​ahg.​12155
24.
Teler J et al (2016) CCL2, CCL5, IL4 and IL15 gene polymorphisms in women with gestational Diabetes Mellitus. Horm Metab Res (Epub ahead of print)
25.
Huynh J et al (2014) A systematic review of metabolite profiling in gestational diabetes mellitus. Diabetologia. doi:10.​1007/​s00125-014-3371-0 PubMedPubMedCentral
26.
International Association of Diabetes and Pregnancy Study Groups-Lewis R et al (2015) Metabolomic profiling in the prediction of gestational diabetes mellitus. Diabetologia. doi:10.​1007/​s00125-015-3553-4
27.
Dudzik D et al (2014) Metabolic fingerprint of gestational Diabetes Mellitus. J Proteomics. doi:10.​1016/​j.​jprot.​2014.​03.​025 PubMed
28.
Liu T et al (2016) Comprehensive analysis of serum metabolites in gestational diabetes mellitus by UPLC/Q-TOF-MS. Anal Bioanal Chem. doi:10.​1007/​s00216-015-9211-3 PubMedCentral
29.
Roverso M et al (2016) A preliminary study on human placental tissue impaired by gestational diabetes: a comparison of gel-based versus gel-free proteomics approaches. Eur J Mass Spectrom (Chichester). doi:10.​1255/​ejms.​1412
30.
Reichetzeder C et al (2016) Increased global placental DNA methylation levels are associated with gestational diabetes. Clin Epigenetics. doi:10.​1186/​s13148-016-0247-9 PubMedPubMedCentral
31.
Coughlan MT et al (2004) Altered placental oxidative stress status in gestational diabetes mellitus. Placenta 25:78–84CrossRefPubMed
32.
Ehrlich S et al (2016) Endocrine disruptors: a potential risk factor for gestational Diabetes Mellitus. Am J Perinatol 33:1313–1318CrossRefPubMed
33.
Feig DS et al (2008) Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. doi:10.​1503/​cmaj.​080012 PubMedPubMedCentral
34.
Carpenter MW (2007) Gestational diabetes, pregnancy hypertension, and late vascular disease. Diabetes Care. doi:10.​2337/​dc07-s224
35.
Kitzmiller JL et al (2007) Gestational diabetes after delivery. Short-term management and long-term risks. Diabetes Care. doi:10.​2337/​dc07-s221
36.
Wasalathanthri S (2015) Attenuating type 2 diabetes with postpartum interventions following gestational diabetes mellitus. World. J Diabetes. doi:10.​4239/​wjd.​v6.​i4.​648
37.
Metzger BE (2007) Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynecol 50:972–979CrossRefPubMed
38.
Pirkola J et al (2010) Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care. doi:10.​2337/​dc09-1871 PubMedPubMedCentral
39.
Crume TL et al (2011) Association of exposure to diabetes in utero with adiposity and fat distribution in a multiethnic population of youth: the exploring perinatal outcomes among children (EPOCH) study. Diabetologia. doi:10.​1007/​s00125-010-1925-3
40.
West NA et al (2011) Cardiovascular risk factors in children exposed to maternal diabetes in utero. Diabetologia. doi:10.​1007/​s00125-010-2008-1
41.
Tam WH et al (2008) Glucose intolerance and cardiometabolic risk in children exposed to maternal gestational diabetes mellitus in utero. Pediatrics. doi:10.​1542/​peds.​2008-0158
42.
Coustan DR et al (1989) Maternal age and screening for gestational diabetes: a population-based study. Obstet Gynecol 73:557–561PubMed
43.
Bentley. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy, 2013. http://​apps.​who.​int/​iris/​bitstream/​10665/​85975/​1/​WHO_​NMH_​MND_​13.​2_​eng.​pdf. Accessed 20 Oct 2016
44.
AACE (2011) American Association of Clinical Endocrinologists medical guidelines for developing a diabetes mellitus comprehensive care plan. Endocrin Pract 17:1–53
45.
World Health Organisation Clinical Practice Guidelines Expert Committee (2008) Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 32:S168–180
46.
Canadian Diabetes Association no 504 (2011) Screening and diagnosis of gestational diabetes mellitus. Obstet Gynecol. doi:10.​1097/​AOG.​0b013e3182310cc3​
47.
Vandorsten JP et al (2013) NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 29:1–31PubMed
48.
Committee Opinion. Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical guideline NG3 article online. 2015. http://​www.​nice.​org.​uk/​guidance/​ng3/​resources/​diabetes-in-pregnancy-management-of-diabetes-and-itscomplications​-from-preconception-to-the-postnatal-period-51038446021. Accessed 20 Oct 2016
49.
National Institute for Health and Care Excellence (NICE). National clinical guideline 116: Management of Diabetes Edinburgh: SIGN article online. 2010. http://​www.​sign.​ac.​uk/​pdf/​sign116.​pdf. Accessed 20 Oct 2016
50.
Linea guida Gravidanza fisiologica. Sistema nazionale per le linee guida dell’Istituto Superiore di Sanità. http://​www.​snlg-iss.​it/​cms/​files/​Lg.​Gravidanza.​pdf. Accessed 20 Oct 2016
51.
Gillespie P et al (2013) Modeling the independent effects of gestational diabetes mellitus on maternity care and costs. Diabetes Care. doi:10.​2337/​dc12-0461
52.
Rani PR, Begum J (2016) Screening and diagnosis of gestational diabetes mellitus, where do we stand. J Clin Diagn Res. doi:10.​7860/​JCDR/​2016/​17588.​7689
53.
Griffin ME et al (2000) Universal versus risk factor based screening for gestational diabetes mellitus detection rates, gestation at diagnosis and outcome. Diabet Med 17:26–32CrossRefPubMed
54.
Williams CB et al (1999) Effect of selective screening for gestational diabetes. Diabetes Care 22:418–421CrossRefPubMed
55.
IDF Clinical Guidelines Task Force. Global guideline on pregnancy and diabetes. Brussels: International Diabetes Federation. 2009. http://​www.​idf.​org/​webdata/​docs/​Pregnancy_​EN_​RTP.​pdf. Accessed 20 Oct 2016
56.
Long H (2011) Diagnosing gestational diabetes: can expert opinions replace scientific evidence? Diabetologia. doi:10.​1007/​s00125-011-2228-z
57.
Cundy T (2012) Proposed new diagnostic criteria for gestational diabetes—a pause for thought? Diabet Med. doi:10.​1111/​j.​1464-5491.​2011.​03407.​x PubMed
58.
Scottish Intercollegiate Guidelines Network Maternal and Health Division, National Guidelines for Diagnosis and Management of Gestational Diabetes Mellitus: Ministry of Health and Family Welfare, New Concept Information Systems, New Delhi, India, 2014
59.
Vij P (2015) Comparison of DIPSI and IADPSG criteria for diagnosis of GDM: a study in a north Indian tertiary care center. Int J Diabetes Dev Ctries. doi:10.​1007/​s13410-014-0244-5
60.
Trujillo J et al (2015) Impact of the International Association of Diabetes and Pregnancy Study Groups criteria for gestational diabetes. Diabetes Res Clin Pract. doi:10.​1016/​j.​diabres.​2015.​02.​007 PubMed
61.
Benhalima K et al (2013) Analysis of pregnancy outcomes using the new IADPSG recommendation compared with the Carpenter and Coustan criteria in an area with a low prevalence of gestational diabetes. Int J Endocrinol. doi:10.​1155/​2013/​248121 PubMedPubMedCentral
62.
Capula C et al (2016) A new predictive tool for the early risk assessment of gestational diabetes mellitus. Prim Care Diabetes. doi:10.​1016/​j.​pcd.​2016.​05.​004 PubMed
63.
Lapolla A et al (2009) Management of gestational diabetes mellitus. Diabetes Metab Syndr Obes 2:73–82CrossRefPubMedPubMedCentral
64.
Landon MB et al (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. N Eng J Med. doi:10.​1056/​NEJMoa0902430
65.
Nguyen TH et al (2016) Are there benefits for gestational diabetes mellitus in treating lower levels of hyperglycemia than standard recommendations? Can. J Diabetes. doi:10.​1016/​j.​jcjd.​2016.​05.​009
66.
de Veciana M et al (1995) Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med 333:1237–1241. doi:10.​1056/​NEJM199511093331​901 CrossRefPubMed
67.
Evers IM et al (2002) Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands. Diabetologia 45:1484–1489CrossRefPubMed
68.
Trumbo P et al (2002) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 102:1621–1630CrossRefPubMed
69.
Uplinger N (2009) The controversy continues: Nutritional management of the pregnancy complicated by diabetes. Curr Diab Rep 9:291–295CrossRefPubMed
70.
Hernandez TL et al (2016) Women with gestational diabetes mellitus randomized to a higher-complex carbohydrate/low-fat diet manifest lower adipose tissue insulin resistance, inflammation, glucose, and free fatty acids: a pilot study. Diabetes Care. doi:10.​2337/​dc15-0515
71.
Song C et al (2016) Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials. Obes Rev. doi:10.​1111/​obr.​12442
72.
Kimber-Trojnar Z et al (2008) Glyburide for the treatment of gestational diabetes mellitus. Pharmacol Rep 60:308–318PubMed
73.
Rowan JA et al (2008) Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. doi:10.​1056/​NEJMoa0707193 PubMed
74.
Government of India (2008) Diabetes in pregnancy. Revised reprint July 2008. RCOG Press, London. http://​www.​nice.​org.​uk
75.
Langer O et al (2000) A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 343:1134–1138. doi:10.​1056/​NEJM200010193431​601 CrossRefPubMed
76.
Dhulkotia JS et al (2010) Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and metaanalysis. Am J Obstet Gynecol. doi:10.​1016/​j.​ajog.​2010.​06.​044 PubMed
77.
Balsells M et al (2015) Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ. doi:10.​1136/​bmj.​h102 PubMedPubMedCentral
78.
Poel YH et al (2012) Vitamin D and gestational diabetes: a systematic review and metaanalysis. Eur J Intern Med. doi:10.​1016/​j.​ejim.​2012.​01.​007 PubMed
79.
Kampmann U et al (2014) Effects of 12 weeks high dose vitamin D3 treatment on insulin sensitivity, beta cell function, and metabolic markers in patients with type 2 diabetes and vitamin D insufficiency - a double-blind, randomized, placebo-controlled trial. Metabolism. doi:10.​1016/​j.​metabol.​2014.​06.​008 PubMed
80.
Alptekin H et al (2016) Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR. J Endocrinol Invest. doi:10.​1007/​s40618-015-0427-z PubMed
81.
Agha-Jaffar R et al (2016) Gestational diabetes mellitus: does an effective prevention strategy exist? Nat Rev Endocrinol. doi:10.​1038/​nrendo.​2016.​88 PubMed
82.
Koivusalo SB et al (2015) Gestational diabetes mellitus can be prevented by lifestyle intervention: the finnish gestational diabetes prevention study (RADIEL): a randomized controlled trial. Diabetes Care. doi:10.​2337/​dc15-0511 PubMed
83.
Dodd JM et al (2014) Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ. doi:10.​1136/​bmj.​g1285 PubMedPubMedCentral
84.
Simmons D et al (2016) Effect of physical activity and/or healthy eating on GDM risk: the DALI lifestyle study. J Clin Endocrinol Metab jc20163455 (Epub ahead of print)
85.
Wang C et al (2016) Effect of regular exercise commenced in early pregnancy on the incidence of gestational diabetes mellitus in overweight and obese pregnant women: a randomized controlled trial. Diabetes Care. doi:10.​2337/​dc16-1320
86.
Maternal and Health Division. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. doi:10.​1056/​NEJMoa012512
87.
Ratner RE et al (2008) Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. doi:10.​1210/​jc.​2008-0772 PubMedCentral
88.
Syngelaki A et al (2016) Metformin versus placebo in obese pregnant women without diabetes mellitus. N Engl J Med. doi:10.​1056/​NEJMoa1509819
89.
Khattab S et al (2011) Can metformin reduce the incidence of gestational diabetes mellitus in pregnant women with polycystic ovary syndrome? Prospective cohort study. Gynecol Endocrinol. doi:10.​3109/​09513590.​2010.​540600
90.
Vanky E et al (2010) Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multi center study. J Clin Endocrinol Metab. doi:10.​1210/​jc.​2010-0853 PubMed
91.
D’Anna R et al. Myo-inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo controlled study. Diabetes Care. doi:10.​2337/​dc12-1371
92.
Crawford TJ et al (2015) Antenatal dietary supplementation with myo-inositol in women during pregnancy for preventing gestational diabetes. Cochrane Database Syst Rev. doi:10.​1002/​14651858.​CD011507.​pub2 PubMed
93.
Luoto R et al (2010) Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr. doi:10.​1017/​S000711450999389​8 PubMed
94.
Steinbrook R (2004) Surgery for severe obesity. N Engl J Med. doi:10.​1056/​NEJMp048029
95.
Dalfrà MG et al (2012) Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med. doi:10.​3109/​14767058.​2012.​663829 PubMed
96.
Willis K et al (2016) Bariatric Surgery and the pregnancy complicated by gestational diabetes. Curr Diab Rep. doi:10.​1007/​s11892-016-0716-8 PubMed

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