Ailments and Situations - Diabetes - Gestational Diabetes Mellitus (GDM)

Gestational Diabetes Mellitus (GDM)

Gestational diabetes mellitus (GDM) is the third type of diabetes. It affects two to five percent of all pregnancies. It is considered an abnormality of glucose tolerance that occurs during pregnancy. This type of diabetes usually disappears when the pregnancy is over, but these women have a higher risk of developing NIDDM within the next 10 to 15 years after the end of the pregnancy. It is associated with a high risk of fetal and maternal morbidity and adverse peri-natal outcomes.

During a normal pregnancy, the placenta produces insulin antagonistic hormones (anti-insulin hormones). This increases the mother's requirement for insulin. In some women, this increased demand cannot be met by the b-cells, and abnormal carbohydrate metabolism results, thus diabetes. Hyperglycemia and hyperinsulinemia are both detrimental to the fetus. High maternal blood glucose can lead to a large or heavy baby of its gestational age, congenital abnormalities, spontaneous abortion, or miscarriage. Delivery complications may arise such as shoulder dystocia, brachial plexus injuries, hypoglycemia, hypocalcemia, hyperbilirunemia, and polycythemia (McMahon et al.). Women with GDM have an increased risk of developing preeclampsia, urinary tract infections, polyhydraminos, oligolydraminos, and uterine bleeding of unknown origin (McMahon et al.).

The risk factors for developing GDM include a family history of DM, obesity, previous GDM, advancing maternal age, previous low birth weight or high birth weight infant, previous stillbirth, previous spontaneous or induced abortion, and chronic hypertension (McMahon et al.). Post-partum, these women are re-assessed and defined as having either a previous abnormality of glucose tolerance IGT, or DM.