PREGNANCY DISORDERS AND MATERNAL CONSEQUENCES: Maternal pre-pregnancy risks and postpartum consequences of gestational diabetes.

IN BRIEF: Maternal morbidities both unmodifiable (genetics and prior history) and modifiable (insulin resistance and obesity) are associated with gestational diabetes. This review discusses common risk factors and postpartum consequences.

ABSTRACT: Gestational diabetes mellitus (GDM) is defined by the World Health Organization (WHO) as glucose intolerance of varying severity with first recognition or onset during pregnancy. It can be caused by excess insulin resistance, a failure to augment insulin secretion in response to pregnancy, or both. The risk of developing GDM is affected by several maternal morbidities, some of which are modifiable. Personal or family history of GDM or type 2 diabetes is strongly associated with GDM, and some susceptibility alleles for type 2 diabetes are shared with GDM. Social determinants of health including access to care and nutritional availability are also associated with GDM risk. Obesity is particularly associated with insulin resistance and dyslipidemia, which are risk factors for GDM. These factors are also present in polycystic ovarian syndrome (PCOS), and women with this condition have an elevated risk of GDM. While dysfunctional beta cell compensation may also be present before pregnancy and predispose to GDM, symptoms only manifest in pregnancy. Other factors that may increase the risk of GDM include folic acid supplementation, age of either of the parents and interpregnancy interval. Not only are preexisting maternal morbidities associated with the development of GDM, but women who have experienced a pregnancy complicated by GDM are more likely to develop type 2 diabetes and cardiovascular disease later in life. Whether this relationship is cause-and-effect or due to common underlying risk factors is unknown.