Table of Contents Show
Gestational diabetes mellitus (GDM) is a common complication associated with pregnancy. It leads to severe complications in both mothers and children during pregnancy and childbirth. In this article, we discuss the current understanding of GDM’s causes, diagnosis, and prevention.
What are the dangers of gestational diabetes?
It is a disease that occurs during pregnancy, characterized by hyperglycemia and insulin resistance. GDM differs from type 1 and type 2 diabetes. Diabetes during pregnancy has serious consequences, but its clinical picture disappears after delivery. A person with diabetes types 1 and 2 has the disease for the rest of his or her life.
There are many complications associated with GDM:
- Developing diabetic fetopathy in a fetus. A child with diabetic fetopathy is usually born overweight (more than 4 kilograms), which can result in birth trauma. The appearance of these patients is similar to that of patients with Cushing’s syndrome: a long torso, short limbs, and a crimson-red “moon-shaped” face. In infants who develop caudal dyskinesia, the sacrum, coccyx, and lumbar vertebrae do not develop, along with abnormalities in brain and other internal organ development.
- Preeclampsia is a dangerous condition that occurs in late pregnancy and leads to high blood pressure, protein excretion in the urine, and multiple organ failure.
- An eclampsia is a dangerous form of preeclampsia where blood pressure reaches such high levels that there is a risk to mother and fetus’ lives.
There is often the need for an emergency caesarean section in both preeclampsia and eclampsia.
The insidiousness of gestational diabetes lies in the fact that it often progresses without obvious symptoms. A woman may experience fatigue, weakness, frequent urination; however, these symptoms are also characteristic of normal pregnancy. Competent and timely diagnosis of GDM is particularly important since there are no specific symptoms.
Factors contributing to gestational diabetes
A woman’s metabolic processes, including her carbohydrate metabolism, change during pregnancy. A growing fetus needs energy, which is mainly provided by maternal glucose. Placenta and fetus receive this glucose through special transport proteins. A fetus uses it much faster than an adult. A mother’s body loses glucose more rapidly at night when she sleeps and does not eat. Due to this, pregnant women have lower glucose levels in the morning on an empty stomach than the general population.
The situation is quite different with postprandial glycemia – blood glucose levels 2 hours after a meal. It is higher in pregnant women than in the general population. The placenta produces hormones that, in their biological effects, act as insulin antagonists and cause insulin resistance to develop.
As a result of insulin resistance, the pancreas’ beta cells begin to produce insulin actively, which leads to compensatory hyperinsulinemia. Insulin production increases by 2–2.5 times in pregnant women.
It is possible for this compensatory mechanism to go awry in some cases, and a woman will develop gestational diabetes as a result. Several risk factors are identified for gestational diabetes by scientists.
1. The problem of overweight and obesity
One of the most common risk factors for GDM is obesity. Overweight and obesity can lead to insulin resistance in non-pregnant women as well. Placental hormones cause insulin resistance to increase during pregnancy, so even increased insulin production cannot compensate. Thus, carbohydrate metabolism is disrupted in women and GDM develops.
In between 2011 and 2019, American scientists studied nearly 12 million medical records of women who gave birth. The results were stratified based on race and ethnicity.
One in ten overweight and one in three obese women reported gestational diabetes in most groups.
People who are obese have abnormal levels of adipokines, adipocyte hormones that affect many bodily processes, including glucose metabolism. As an example, obesity leads to elevated leptin levels, which disrupt adipose tissue’s glucose utilization.
All women experience an increase in this hormone during pregnancy. The placenta also produces it. Clinical studies, however, show that obese women have much higher levels throughout pregnancy. A 10 ng / ml increase in leptin concentration increases the risk of developing diabetes by 20% in pregnant women.
Monocytes and macrophages from adipose tissue produce pro-inflammatory cytokines, which modulate inflammation. In obesity, cytokines increase, causing chronic inflammation of adipose tissue, damage to insulin receptors, and insulin resistance.
Among the pro-inflammatory cytokines is TNF-α (tumor necrosis factor). Compared to healthy pregnant women, pregnant women with gestational diabetes have a much higher level of this cytokine.
2. Predisposition due to genetics
Scientists suggest that GDM and other forms of diabetes are caused by similar changes in the hereditary cell apparatus. Studying the metabolomes of patients with gestational diabetes and other diabetic forms revealed significant similarities in biochemical disruptions.
Metabolomes are collections of very small molecules that are the products of metabolism. The compounds may include amino acids, organic acids, sugars, nucleotides, and many others. Molecular analyses of the metabolome reveal what dynamic processes in the body occur, as well as the molecular causes of certain diseases.
Women with gestational diabetes over the next 5–12 years are 14.7% more likely to develop type 1 diabetes and 20% more likely to develop type 2 diabetes.
As gestational diabetes is more likely to be associated with type 2 diabetes, scientists are actively studying DNA markers associated with type 2 diabetes in women with gestational diabetes. Genetic mutations have been found to decrease tissue sensitivity to insulin, malfunction beta cells, and impair carbohydrate and lipid metabolism in pregnant women with GDM. Diabetes type 2 patients also have mutations in these genes.
The ABCC8 gene, which encodes the Sur1 protein, is one candidate gene associated with gestational diabetes. This protein is part of potassium channels, which regulate a number of cellular processes, including hormone production. Beta cell insulin production is regulated by these channels, which open and close according to blood glucose levels. In the event that the ABCC8 gene is mutated, insulin production is impaired.
3. Polycystic ovarian syndrome
Obesity, insulin resistance, and impaired ovaries are all symptoms of polycystic ovary syndrome (PCOS). Women with this disease are at risk of developing gestational diabetes during pregnancy.
Researchers from Wenzhou Medical University performed a large-scale meta-analysis to determine if PCOS is associated with pregnancy complications, including gestational diabetes. A total of 40 studies were analyzed, and 29 showed a significant association between PCOS and GDM.
In addition, PCOS increases the risk of preeclampsia, gestational hypertension, spontaneous abortion, preterm delivery, caesarean section, hypoglycemia, and perinatal death.
4. Arterial hypertension
209 pregnant women participated in a study conducted by the research center of the Ministry of Health of Russia. A glucose tolerance test revealed that 70 women had GDM.
High blood pressure has been identified as one of the risk factors for diabetes in pregnant women. According to the researchers, any hypertension during the first trimester of pregnancy increases the risk of the disease by three times. Even if hypertension can be managed with medication, the risk does not decrease.
Researchers also found that many women with GDM had relatives with diabetes, oligomenorrhea before conception, and miscarriages. Multiparous women were most likely to develop gestational diabetes.
Gestational diabetes treatment methods
In most cases, gestational diabetes is treated with a special diet that excludes fast carbohydrates. Women with GDM should also maintain an active lifestyle, monitor their glycemia, and urine ketones.
Diabetes patients who fail to reach their glycemic targets with diet and an active lifestyle may be prescribed insulin therapy. Hypoglycemic agents used to treat type 2 diabetes are not prescribed to pregnant women, because they have more side effects than genetically engineered insulins.
Preventing gestational diabetes
Even though it may seem trite, a healthy lifestyle before pregnancy is the key to preventing GDM. Physical activity, a healthy diet, and smoking cessation reduce the risk of gestational diabetes by 41%, according to clinical studies.
A healthy diet and physical activity can help prevent obesity, which increases the risk of gestational diabetes, PCOS, and type 2 diabetes. By quitting smoking, you reduce your chances of developing hypertension, which is also a risk factor.
Responses