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Review
. 2022 Feb 12:45:101294.
doi: 10.1016/j.eclinm.2022.101294. eCollection 2022 Mar.

The life course perspective of gestational diabetes: An opportunity for the prevention of diabetes and heart disease in women

Jennifer Fu  1   2 , Ravi Retnakaran  1   2   3
Affiliations
Review

The life course perspective of gestational diabetes: An opportunity for the prevention of diabetes and heart disease in women

Jennifer Fu et al. EClinicalMedicine. .

Abstract

Gestational diabetes mellitus (GDM), which has traditionally been defined as glucose intolerance of varying severity with first onset in pregnancy, is rising in prevalence with maternal hyperglycemia currently affecting one in every six pregnancies worldwide. Although often perceived as a medical complication of pregnancy, GDM is actually a chronic cardiometabolic disorder that identifies women who have an elevated lifetime risk of ultimately developing type 2 diabetes and cardiovascular disease. In identifying high-risk women early in the natural history of these conditions, the diagnosis of GDM raises the tantalizing possibility of early intervention and risk modification. However, before such promise can be realized in practice, a series of clinical challenges/obstacles (reviewed herein) must be overcome. Ultimately, the coupling of this life course perspective of GDM with concerted efforts to overcome these challenges may enable fulfilment of this unique opportunity for the primary prevention of diabetes and heart disease in women.

Keywords: Cardiovascular disease; Gestational diabetes; Prevention; Type 2 diabetes; Women's health.

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Conflict of interest statement

Dr. Fu has nothing to disclose. Dr. Retnakaran reports grants and other from Boehringer Ingelheim, grants and personal fees from Novo Nordisk, personal fees from Sanofi, personal fees from Eli Lilly, other from Sun Life Financial, outside the submitted work. Dr. Retnakaran also holds the Boehringer Ingelheim Chair in Beta-cell Preservation, Function and Regeneration at Mount Sinai Hospital.

Figures

Figure 1
Figure 1
Schematic showing the life course perspective of insulin resistance, beta-cell function, and glycemia in a woman with GDM. Specifically, women with GDM have a chronic beta-cell defect that leads to rising glycemia even before pregnancy. When pregnant, insufficient beta-cell compensation for the insulin resistance of the latter half of gestation yields the hyperglycemia by which GDM is identified. Upon delivery and abatement of the insulin resistance of pregnancy, glycemia initially improves. However, the ongoing deterioration of beta-cell function leads to rising glycemia over time that may ultimately reach the diagnostic threshold for diabetes.
Figure 2
Figure 2
The life course perspective of GDM encompasses underlying metabolic defects, an adverse cardiometabolic risk factor profile that worsens over time, and elevated lifetime risks of cardiometabolic disease outcomes and associated advanced complications.
See this image and copyright information in PMC

References

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