Diabetes during pregnancy carries important implications for mother and child. Recent evidence has clarified the relationship of maternal glycaemia to neonatal outcomes and demonstrated that appropriate detection and treatment can improve outcomes. This review examines normal physiological changes of glucose metabolism in pregnancy and the association of gestational diabetes with complications both at time of delivery (macrosomia, hypoglycaemia, jaundice, polycythaemia, respiratory distress syndrome, and hypocalcaemia) and later disease associations for both mother and child. Finally recent evidence that at least some of these adverse effects can be reduced is examined.Br J Diabetes Vasc Dis 2009; 9: 27—31
Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: WHO, 1999.
2.
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JSEffect of treatment of gestational diabetes mellitus on pregnancy outcomes . N Engl J Med2005;352:2477-86.
3.
Rowan JA, Hague WM, Gao W., Battin MR, Moore MPMetformin versus insulin for the treatment of gestational diabetes. N Engl J Med2008;358:2003-15.
4.
Metzger BE, Lowe LP, Dyer AR et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med2008;358:1991-2002.
5.
Dabelea D., Snell-Bergeon JK, Hartsfield CL, Bischoff KJ, Hamman RF, McDuffie RSIncreasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort: Kaiser Permanente of Colorado GDM Screening Program. Diabetes Care2005;28:579-84.
6.
Wild S., Roglic G., Green A., Sicree R., King H.Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care2004;27:1047-53.
7.
Buchanan TA, Xiang AH, Peters RK et al. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. Diabetes2002;51:2796-803.
8.
Lain KY, Catalano PMMetabolic changes in pregnancy. Clin Obstet Gynecol2007;50:938-48.
9.
Metzger BE, Phelps RL, Freinkel N., Navickas IAEffects of gestational diabetes on diurnal profiles of plasma glucose, lipids, and individual amino acids. Diabetes Care1980;3:402-09.
10.
Parretti E. , Mecacci F., Papini M. et al. Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies: correlation with sonographic parameters of fetal growth. Diabetes Care2001; 24:1319-23.
11.
Catalano PM , Tyzbir ED, Wolfe RR et al. Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes. Am J Physiol1993;264:E60-7.
12.
Frayling TMGenome-wide association studies provide new insights into type 2 diabetes aetiology. Nat Rev Genet2007;8:657-62.
13.
Robitaille J., Grant AMThe genetics of gestational diabetes mellitus: evidence for relationship with type 2 diabetes mellitus. Genet Med2008;10:240-50.
14.
Kirwan JP, Hauguel-de Mouzon S., Lepercq J. et al. TNF-alpha is a predictor of insulin resistance in human pregnancy . Diabetes2002;51:2207-13.
15.
Kuzawa CWAdipose tissue in human infancy and childhood: an evolutionary perspective . Am J Phys Anthropol1998;107(Suppl 27):177-209.
16.
Kjos SL, Buchanan TAGestational diabetes mellitus. N Engl J Med1999;341:1749-56.
17.
Pedersen J.Weight and length at birth in infants of diabetic mothers. Acta Endocrinologica1954;16:330-42.
18.
Freinkel N.Banting Lecture 1980. Of pregnancy and progeny. Diabetes1980;29:1023-35.
19.
Schmidt MI, Duncan BB, Reichelt AJ et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care2001; 24:1151-5.
20.
Naylor CD, Sermer M., Chen E., Sykora K.Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators. JAMA1996;275:1165-70.
21.
Langer O., Conway DL, Berkus MD, Xenakis EM, Gonzales O.A comparison of glyburide and insulin in women with gestational diabetes mellitus . N Engl J Med2000;343:1134-8.
22.
Glueck CJ, Goldenberg N., Pranikoff J., Loftspring M., Sieve L., Wang P.Height, weight, and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod2004;19:1323-30.
23.
Sinha B., Brydon P., Taylor RS et al. Maternal ante-natal parameters as predictors of persistent postnatal glucose intolerance: a comparative study between Afro-Caribbeans, Asians and Caucasians. Diabet Med2003;20:382-6.
24.
Kim C., Newton KM, Knopp RHGestational diabetes and the incidence of type 2 diabetes: a systematic review . Diabetes Care2002;25:1862-8.
25.
Lee AJ, Hiscock RJ, Wein P., Walker SP, Permezel M.Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 diabetes: a retrospective cohort study using survival analysis. Diabetes Care2007;30:878-83.
26.
White PWChildhood diabetes: Its course and influence in the second and third generations . Diabetes1960;9:345-55.
27.
Pettitt DJ, Aleck KA, Baird HR, Carraher MJ, Bennett PH, Knowler WCCongenital susceptibility to NIDDM. Role of intrauterine environment. Diabetes1988;37:622-8.
28.
Pettitt DJ, Knowler WC, Bennett PH, Aleck KA, Baird HRObesity in offspring of diabetic Pima Indian women despite normal birth weight . Diabetes Care1987;10:76-80.
29.
Pettitt DJ, Baird HR, Aleck KA, Bennett PH, Knowler WCExcessive obesity in offspring of Pima Indian women with diabetes during pregnancy . N Engl J Med1983;308:242-5.
30.
Dabelea D., Hanson RL, Bennett PH et al. Intrauterine exposure to diabetes conveys risk for diabetes and obesity in offspring above that attributable to genetics. Diabetes1999;48:A52.
31.
Weiss PA, Scholz HS, Haas J., Tamussino KF, Seissler J., Borkenstein MHLong-term follow-up of infants of mothers with type 1 diabetes: evidence for hereditary and nonhereditary transmission of diabetes and precursors. Diabetes Care2000;23:905-11.
32.
Clausen TD, Mathiesen ER, Hansen T. et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care2008;31:340-6.
33.
Vohr BR, McGarvey ST, Tucker R.Effects of maternal gestational diabetes on offspring adiposity at 4-7 years of age. Diabetes Care1999; 22:1284-91.
34.
Vohr BR, Boney CMGestational diabetes: the forerunner for the development of maternal and childhood obesity and metabolic syndrome?J Matern Fetal Neonatal Med2008;21:149-57.
35.
Ong KK, Diderholm B., Salzano G. et al. Pregnancy insulin, glucose and BMI contribute to birth outcomes in non-diabetic mothers. Diabetes Care2008 ;(Epub ahead of print).
