Maternal outcomes and follow-up after gestational diabetes mellitus

Abstract

Gestational diabetes mellitus reflects impaired maternal insulin secretion relative to demand prior to pregnancy, as well as temporary metabolic stressors imposed by the placenta and fetus. Thus, after delivery, women with gestational diabetes have increased risk of diabetes and recurrent gestational diabetes because of their underlying impairment, which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours. This hypothetical model is discussed in greater detail, particularly the uncertainty regarding pregnancy as an accelerator of β-cell decline and the role of gestational weight gain. This report also presents risk estimates for future glucose intolerance and diabetes and reviews modifiable risk factors, particularly body mass and lifestyle alterations, including weight loss and breastfeeding. Non-modifiable risk factors such as race/ethnicity and insulin use during pregnancy are also discussed. The review concludes with current literature on lifestyle modification, recommendations for post-partum glucose screening, and future directions for research to prevent maternal disease.

Figure 1

Pre-conception maternal insulin sensitivity and secretion, in conjunction with placental and fetal hormone production, influence intra-partum maternal fat accumulation as well as insulin secretion and sensitivity. Thus, post-partum glucose tolerance reflects pre-conception metabolism altered by the adipose tissue gained during pregnancy, possibly stresses upon the pancreatic β-cell possibly accelerated by the pregnancy, fat stores accumulated during pregnancy and retained after delivery and post-partum behaviours.