Gestational Diabetes Mellitus: an Opportunity to Prevent Type 2 Diabetes and Cardiovascular Disease in Young Women

Graziano Di Cianni; Alessandra Ghio; Veronica Resi; Laura Volpe

Disclosures

Women's Health. 2010;6(1):97-105. 

In This Article

Abstract and Introduction

Abstract

In women with previous gestational diabetes (pGDM), the risk of developing Type 2 diabetes is greatly increased, to the point that GDM represents an early stage in the natural history of Type 2 diabetes. In addition, in the years following the index pregnancy, women with pGDM exhibit an increased cardiovascular risk profile and an increased incidence of cardiovascular disease. This paper will review current knowledge on the metabolic modifications that occur in normal pregnancy, underlining the mechanism responsible for GDM, the link between these alterations and the associated long-term maternal complications. In women with pGDM, accurate follow-up and prevention strategies (e.g., weight control and regular physical exercise) are needed to reduce the subsequent development of overt diabetes and other metabolic abnormalities related to cardiovascular disease. Therefore, our paper will provide arguments in favor of performing follow-up programs aimed at modifying risk factors involved in the pathogenesis of Type 2 diabetes and cardiovascular disease.

Introduction

Gestational diabetes mellitus (GDM), defined as "glucose intolerance of any degree with onset or first recognition during pregnancy," is a common complication in pregnancy, occurring in 4–7% of pregnant women; it represents 90% of all cases of diabetes mellitus that are diagnosed during pregnancy.[1]

Incidence rates of GDM are increasing in all ethnic groups, reflecting the increased prevalence of obesity and Type 2 diabetes mellitus (T2DM) within the general population. Both obesity and a family history of T2DM represent important risk factors for the development of GDM.[2–4]

In the short term, GDM is associated with an increased risk of adverse obstetrical outcomes, particularly those related to fetal overgrowth, which include macrosomia, shoulder dystocia, birth injury, prematurity and an increased Caesarean section rate.[5]

Despite normal glucose tolerance in the immediate postpartum, women with GDM are at high risk for subsequent development of metabolic diseases. Development of T2DM, for instance, is much greater among women with previous GDM (pGDM). These women also tend to display features of metabolic syndrome (MS) such as hypertension, dyslipidemia and microalbuminuria, which increase the risk for atherogenic insult.[6] Women with pGDM should, therefore, be enrolled in follow-up programs designed to ensure continuous surveillance with the aim of providing effective prevention of T2DM and cardiovascular diseases (CVD).

This review examines the available evidence with regard to the associations between GDM, T2DM and CVD. We also describe possible strategies to prevent these abnormalities in high-risk women, with a focus on lifestyle modification.

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