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11-13-2017 | Gestational diabetes | Editorial | Article

Gestational diabetes mellitus: Opportunity, not despair

Authors: Sanjay Kalra, Ankia Coetzee



The current situation

The accelerating prevalence of diabetes has reached pandemic proportions, especially in women of reproductive age. It is estimated that one in seven births are affected by diabetes [1], and it is known that hyperglycemia during pregnancy has various implications for the mother and her child that extend far beyond pregnancy [2].

The focus of World Diabetes Day 2017 is on women and diabetes. Due to their unique biopsychosocial constitution, women may be more vulnerable to the development of diabetes and its complications [3]. The gender-specific form of diabetes, gestational diabetes mellitus (GDM), is the net result of a pancreatic beta-cell defect unmasked by the concurrent insulin resistance of pregnancy.

Should GDM be viewed as an opportunity, or an inequality, and should it be a cause for dynamism or despair?

The past: Despair and despondency

As recently as a century ago, pregnancy in women with existing diabetes was strongly discouraged due to the unacceptable risk profile. The focus of care was based on a reactive model, where medical attention was concentrated on peripartum intervention and, as a result, investigation of new-onset antenatal hyperglycemia was a rare occurrence. Indeed, the long-term metabolic health of women with diabetes and their children received little attention, as did the possible implications of GDM for future public health.

The present: Awareness and action

Today, GDM is recognized as a distinct subtype of diabetes that is associated with well-recognized short-, medium-, and long-term sequelae, and is a robust predictor of future diabetes. The recent expansion of knowledge in the field of GDM has led to a heightened interest in its management [2]. Why then, should we despair? Why not view GDM as an opportunity?

The future: Opportunity against odds

Management of GDM aims to promote short-, medium-, and long-term feto-maternal metabolic health. It offers a unique opportunity for clinicians to participate in a proactive model of care with a chance to improve the metabolic well-being of current and future generations (Box 1) [4]. Potentially vulnerable groups like antenatal women may also sway political will toward a more salutogenic health policy, with a focus on early prevention, screening, diagnosis, and treatment of diabetes [5, 6].

Box 1. Opportunities offered by GDM.
  • Multisectoral health promotion
    • Individual
    • Community
  • Behavior modification
    • Lifestyle motivation
    • Weight management
  • Health system strengthening
  • Education and empowerment
    • Individual
    • Community
    • Healthcare providers
  • Prediction and prevention of: 
    • diabetes following GDM;
    • diabetic complications with early detection; and
    • metabolic disease in offspring.
  • Health policy planning
GDM: Gestational diabetes mellitus.

GDM management calls for a team effort, and often involves inter- and intra-disciplinary coordination and collaboration. This multidisciplinary team approach not only benefits women with GDM, but also strengthens health systems [5]. Women with GDM have been shown to act as change agents and fulfill important peer-to-peer educational roles. This introduces the potential of up-skilling and empowering women with a condition perceived as being disadvantageous [7].

Perhaps most important of all, women living with GDM, and their treating clinicians, can positively influence the health of the unborn generation by facilitating optimal maternal metabolic health [8].

For our sake and the sake of coming generations, GDM is an opportunity which we cannot afford to miss. 

  1. International Diabetes Federation. World Diabetes Day 2017: Facts and figures. Available at [Accessed 31 October 2017].
  2. Kalra B, Kalra S. Women hold up half the sky, and more. In: Diabetes mellitus: Issues for the Indian woman. Edited by S Bajaj. New Delhi, India. Jaypee, 2017; 9–11.
  3. Mahtab H, Pathan MF, Ahmed T et al. The Dhaka Declaration 2015. Indian J Endocrinol Metab 2015; 19: 441–442.
  4. Kalra S, Coetzee A, Afsana F et al. Gestational diabetes mellitus: Berlin and beyond. J Pak Med Assoc 2017; 67: 641–644.
  5. Kalra S, Gupta Y. Post-partum screening of gestational diabetes: Opportunities for integration with existing public health. Indian J Community Med 2015; 40: 209–210.
  6. Metzger BE, Buchanan TA, Coustan DR et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care 2007; 30(Suppl 2): 251–260.
  7. Gupta Y, Kalra B. Converting disability to opportunity: GDM women as new role models of diabetes care. Indian J Endocrinol Metab 2014; 18: 120–121.
  8. Kalra B, Kalra S, Unnikrishnan AG, Baruah MP, Khandelwal D, Gupta Y. Transgenerational karma. Indian J Endocrinol Metab 2017; 21: 265–267.