Gestational diabetes: Difference between revisions
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== Description == | == Description == | ||
<div>Gestational Diabetes Mellitus (GDM) is characterised by hyperglycaemia first recognised in pregnancy. Its prevalence varies widely in the literature, but is thought to effect 4-7.5% of all pregnancies <ref name="p1" /><ref name="p2">Lawreance, J.M., Contereras, R., Chen, W. and Sacks, D.A. (2008) 'Trends in the prevelance of preexisting diabetes mellitus and GDM among a racially/ethnically diverse population of pregnant women, 1999-2005', Diabetes Care, 31(5), 899-904.</ref> and is increasing <ref name="p1">Dabelea, D., Snell-Bergeon, J.K., Hartsfield, C.L., Bischoff, K.J., Hamman, R.F., McDuffie, R.S. (2005) 'Increasing Prevelance of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort', Diabetes Care, 28(3), 579-584.</ref> more common among older women, obese women and certain ethnic groups<ref name="p2" />. It usually presents after the beginning of the second trimester<ref name="p4">Alwan, N., Tuffnell,D.J., West, J. (2009) 'Treatments for Gestational Diabetes', The Cochrane Library, Issue 3.</ref>.<br></div> | <div>Gestational Diabetes Mellitus (GDM) is characterised by hyperglycaemia first recognised in pregnancy. Its prevalence varies widely in the literature, but is thought to effect 4-7.5% of all pregnancies <ref name="p1" /><ref name="p2">Lawreance, J.M., Contereras, R., Chen, W. and Sacks, D.A. (2008) 'Trends in the prevelance of preexisting diabetes mellitus and GDM among a racially/ethnically diverse population of pregnant women, 1999-2005', Diabetes Care, 31(5), 899-904.</ref> and is increasing <ref name="p1">Dabelea, D., Snell-Bergeon, J.K., Hartsfield, C.L., Bischoff, K.J., Hamman, R.F., McDuffie, R.S. (2005) 'Increasing Prevelance of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort', Diabetes Care, 28(3), 579-584.</ref> more common among older women, obese women and certain ethnic groups<ref name="p2" />. It usually presents after the beginning of the second trimester<ref name="p4">Alwan, N., Tuffnell,D.J., West, J. (2009) 'Treatments for Gestational Diabetes', The Cochrane Library, Issue 3.</ref>.<br></div> | ||
== Pathological Process | == Pathological Process == | ||
In pregnancy, women develop insulin resistance, which | In pregnancy, some women develop insulin resistance, which may stem from increased maternal adiposity and several hormones produced during pregnancy block the action of insulin at a cellular level, i.e. Tumor Necrosis Factor Alpha, human placental lactogen and placental growth hormone. As a result, blood glucose levels rise and more insulin is produced in response. As the pregnancy progress, the insulin demands increase, and thus, insulin resistance also increases due to rising levels of pregnancy hormones. However, this is a normal physiological change in pregnancy. Beta cells in the pancreas increase insulin production to compensate for this, and so in a normal pregnancy blood glucose level changes are small compared to the large changes in insulin resistance. Women who present with gestational diabetes mellitus have less of a degree of compensation at the Beta cell than women who do not present with gestational diabetes <ref name="p6">Bergman, R.N.(1989) 'Toward a physiological un derstanding of glucose tolerance: minimal model approach', Diabetes, 51, 2207-2213.</ref>. Less than 10% of women who present with gestational diabetes have been shown to have antibodies to pancreatic islets of Beta cells in their circulation. It has been postulated that their gestational diabetes may stem from autoimmune damage to Beta cells <ref name="p7">Kim, C. and Ferrera, S. (eds.) (2010) Gestational Diabetes During and After Pregnancy, London: Springer-Verlag.</ref>. Some gestational diabetes mellitus cases have been shown to be due to genetic defects in Beta cells <ref name="p7" />. Others may be chronic hyperglycaemia first detected at pregnancy, which may explain why most women who develop gestational diabetes mellitus go on to develop type II diabetes mellitus. The exact mechanism for increased insulin resistance is still largely unclear. Maternal obesity may contribute as up-regulation of cytokines and adipokines impacts insulin pathways and skeletal muscle insulin signalling is impaired <ref name="p7" />. | ||
== Consequences of Gestational Diabetes Mellitus == | == Consequences of Gestational Diabetes Mellitus == | ||
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=== For Mother === | === For Mother === | ||
<span style="line-height: 1.5em;"> | Gestational diabetes mellitus <span style="line-height: 1.5em;">is r</span><span style="line-height: 1.5em;">elated to higher rates of:</span> | ||
<span style="line-height: 1.5em;" />Pre-eclampsia | <span style="line-height: 1.5em;" />Pre-eclampsia | ||
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<span style="line-height: 1.5em;">Caesarean section</span><ref name="p8">HAPO Study Cooperative Research Group (2009) 'Hyperglycaemia and Pregnancy Outcome Study: Associations with neonatal anthropometrics', Diabetes, 58, 453-459.</ref> | <span style="line-height: 1.5em;">Caesarean section</span><ref name="p8">HAPO Study Cooperative Research Group (2009) 'Hyperglycaemia and Pregnancy Outcome Study: Associations with neonatal anthropometrics', Diabetes, 58, 453-459.</ref> | ||
<span style="line-height: 1.5em;"> | Gestational diabetes mellitus <span style="line-height: 1.5em;">in subsequent pregnancies<ref name="p9">Catalano, P.M., Kirwen, T.P., Hougel-de Mouzon, S., King, J. (2003) 'Gestational Diabetes and Insulin Resistance: rolein short- and long-term implications for mother and fetus', J Nutr, 133, 1674S-1683S.</ref></span> | ||
Gestational diabetes mellitus typically resolves after birth. However, there have been many studies detailing the significantly increased risk of developing type II diabetes mellitus after having gestational diabetes mellitus, particularly in the first 5 years postpartum <ref name="p6" />. | |||
=== For Baby === | === For Baby === | ||
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=== Risk Factors === | === Risk Factors === | ||
Several factors have been identified which increase the risk of women developing | Several factors have been identified which increase the risk of women developing gestational diabetes mellitus. These include: | ||
* Older age | |||
Older age | * Ethnicity, namely black, Native American, Pacific Islander, Hispanic, South or East Asian and Indigenous Australian | ||
* High pre-pregnancy BMI | |||
Ethnicity, namely black, Native American, Pacific Islander, Hispanic, South or East Asian and Indigenous Australian | * Family history of diabetes | ||
* Previous episode of gestational diabetes mellitus | |||
High pre-pregnancy BMI | * Multigravid women | ||
* Excessive weight gain during pregnancy | |||
Family history of diabetes | * Short stature | ||
* Smoking<ref name="p6" /><ref name="p7" /> | |||
Previous | |||
Multigravid women | |||
Excessive weight gain during pregnancy | |||
Short stature | |||
Smoking<ref name="p6"/><ref name="p7"/> | |||
<br> | <br> | ||
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=== Screening for Gestational Diabetes Mellitus === | === Screening for Gestational Diabetes Mellitus === | ||
Gestational diabetes mellitus can only be confirmed by an abnormal glucose tolerance test. [https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-recommendation-diagnosis-gestational-diabetes-pregnancy-0 The World Health Organization classify gestational diabetes mellitus] as: | |||
*A fasting blood glucose level of >7mmol/l | *A fasting blood glucose level of >7mmol/l | ||
*A blood glucose level of >7.8mmol/l 2 hours after a 75g glucose drink<ref name="p4" /> | *A blood glucose level of >7.8mmol/l 2 hours after a 75g glucose drink<ref name="p4" /> | ||
== Medical Management / Interventions == | |||
== Medical Management / Interventions | |||
=== Diet === | === Diet === | ||
Dietary interventions<span style="line-height: 1.5em;"> have long been a cornerstone of treatement for GDM. Women diagnosed with GDM are routinely referred to a dietician. The challenge of GDM management for dieticians is striking the delicate balance between keeping maternal insulin low without restricting fetal growth. A Cochrane review in 2008 examined 3 trials investigating the effects of diet on preventing GDM, found inconclusive results <ref name="p9"/>.</span> | Dietary interventions<span style="line-height: 1.5em;"> have long been a cornerstone of treatement for GDM. Women diagnosed with GDM are routinely referred to a dietician. The challenge of GDM management for dieticians is striking the delicate balance between keeping maternal insulin low without restricting fetal growth. A Cochrane review in 2008 examined 3 trials investigating the effects of diet on preventing GDM, found inconclusive results <ref name="p9" />.</span> | ||
=== Medication === | === Medication === | ||
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=== Weight Management === | === Weight Management === | ||
== The Role for Physiotherapy | == The Role for Physiotherapy == | ||
=== Physiotherapy in the <span style="line-height: 1.5em;">Management</span><span style="line-height: 1.5em;"> of Gestational Diabetes Mellitus</span> === | === Physiotherapy in the <span style="line-height: 1.5em;">Management</span><span style="line-height: 1.5em;"> of Gestational Diabetes Mellitus</span> === | ||
<div><span style="line-height: 1.5em;"> | <div><span style="line-height: 1.5em;"></span></div> | ||
</span></div> | |||
<br> | <br> | ||
=== Physiotherapy in the <span style="line-height: 1.5em;">Prevention</span><span style="line-height: 1.5em;"> of Gestational Diabetes Mellitus</span> === | === Physiotherapy in the <span style="line-height: 1.5em;">Prevention</span><span style="line-height: 1.5em;"> of Gestational Diabetes Mellitus</span> === | ||
== Resources | == Resources == | ||
Kim and Ferrera (2010) Gestational Diabetes During and After Pregnancy | Kim and Ferrera (2010) Gestational Diabetes During and After Pregnancy | ||
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References will automatically be added here, see [[Adding References|adding references tutorial]]. | References will automatically be added here, see [[Adding References|adding references tutorial]]. | ||
<references/> | <references /> | ||
[[Category:Womens_Health]] | [[Category:Womens_Health]] | ||
Revision as of 19:40, 3 August 2018
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Description[edit | edit source]
Gestational Diabetes Mellitus (GDM) is characterised by hyperglycaemia first recognised in pregnancy. Its prevalence varies widely in the literature, but is thought to effect 4-7.5% of all pregnancies [1][2] and is increasing [1] more common among older women, obese women and certain ethnic groups[2]. It usually presents after the beginning of the second trimester[3].
Pathological Process[edit | edit source]
In pregnancy, some women develop insulin resistance, which may stem from increased maternal adiposity and several hormones produced during pregnancy block the action of insulin at a cellular level, i.e. Tumor Necrosis Factor Alpha, human placental lactogen and placental growth hormone. As a result, blood glucose levels rise and more insulin is produced in response. As the pregnancy progress, the insulin demands increase, and thus, insulin resistance also increases due to rising levels of pregnancy hormones. However, this is a normal physiological change in pregnancy. Beta cells in the pancreas increase insulin production to compensate for this, and so in a normal pregnancy blood glucose level changes are small compared to the large changes in insulin resistance. Women who present with gestational diabetes mellitus have less of a degree of compensation at the Beta cell than women who do not present with gestational diabetes [4]. Less than 10% of women who present with gestational diabetes have been shown to have antibodies to pancreatic islets of Beta cells in their circulation. It has been postulated that their gestational diabetes may stem from autoimmune damage to Beta cells [5]. Some gestational diabetes mellitus cases have been shown to be due to genetic defects in Beta cells [5]. Others may be chronic hyperglycaemia first detected at pregnancy, which may explain why most women who develop gestational diabetes mellitus go on to develop type II diabetes mellitus. The exact mechanism for increased insulin resistance is still largely unclear. Maternal obesity may contribute as up-regulation of cytokines and adipokines impacts insulin pathways and skeletal muscle insulin signalling is impaired [5].
Consequences of Gestational Diabetes Mellitus[edit | edit source]
For Mother[edit | edit source]
Gestational diabetes mellitus is related to higher rates of:
<span style="line-height: 1.5em;" />Pre-eclampsia
Caesarean section[6]
Gestational diabetes mellitus in subsequent pregnancies[7]
Gestational diabetes mellitus typically resolves after birth. However, there have been many studies detailing the significantly increased risk of developing type II diabetes mellitus after having gestational diabetes mellitus, particularly in the first 5 years postpartum [4].
For Baby[edit | edit source]
- Macrosomnia: leading to higher rates of injury to mother and baby [7], and higher rates of childhood overweight and obesity [8]
- Fetal hyperglycaemia and hyperinsulinimia
- Preterm delivery
- Intensive neonatal care
- High neonatal body fat percentage
- Clinical neonatal hypoglycaemia [6]
Diagnositc Procedures[edit | edit source]
Risk Factors[edit | edit source]
Several factors have been identified which increase the risk of women developing gestational diabetes mellitus. These include:
- Older age
- Ethnicity, namely black, Native American, Pacific Islander, Hispanic, South or East Asian and Indigenous Australian
- High pre-pregnancy BMI
- Family history of diabetes
- Previous episode of gestational diabetes mellitus
- Multigravid women
- Excessive weight gain during pregnancy
- Short stature
- Smoking[4][5]
Local regimens use various screening tools in conjunction with these risk factors to identify women in need of further testing.
Screening for Gestational Diabetes Mellitus[edit | edit source]
Gestational diabetes mellitus can only be confirmed by an abnormal glucose tolerance test. The World Health Organization classify gestational diabetes mellitus as:
- A fasting blood glucose level of >7mmol/l
- A blood glucose level of >7.8mmol/l 2 hours after a 75g glucose drink[3]
Medical Management / Interventions[edit | edit source]
Diet[edit | edit source]
Dietary interventions have long been a cornerstone of treatement for GDM. Women diagnosed with GDM are routinely referred to a dietician. The challenge of GDM management for dieticians is striking the delicate balance between keeping maternal insulin low without restricting fetal growth. A Cochrane review in 2008 examined 3 trials investigating the effects of diet on preventing GDM, found inconclusive results [7].
Medication[edit | edit source]
When dietary management fails, insulin is considered the safest treatment, as free insulin cannot cross the placenta. Alpha-glucosidase inhibitors (acarbose) and biguanides (metformin) cross placenta but are still used increasingly. However, there are insufficient data to determine the long term effects of these on mother and baby [9].
Weight Management[edit | edit source]
The Role for Physiotherapy[edit | edit source]
Physiotherapy in the Management of Gestational Diabetes Mellitus[edit | edit source]
Physiotherapy in the Prevention of Gestational Diabetes Mellitus[edit | edit source]
Resources[edit | edit source]
Kim and Ferrera (2010) Gestational Diabetes During and After Pregnancy
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 Dabelea, D., Snell-Bergeon, J.K., Hartsfield, C.L., Bischoff, K.J., Hamman, R.F., McDuffie, R.S. (2005) 'Increasing Prevelance of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort', Diabetes Care, 28(3), 579-584.
- ↑ 2.0 2.1 Lawreance, J.M., Contereras, R., Chen, W. and Sacks, D.A. (2008) 'Trends in the prevelance of preexisting diabetes mellitus and GDM among a racially/ethnically diverse population of pregnant women, 1999-2005', Diabetes Care, 31(5), 899-904.
- ↑ 3.0 3.1 Alwan, N., Tuffnell,D.J., West, J. (2009) 'Treatments for Gestational Diabetes', The Cochrane Library, Issue 3.
- ↑ 4.0 4.1 4.2 Bergman, R.N.(1989) 'Toward a physiological un derstanding of glucose tolerance: minimal model approach', Diabetes, 51, 2207-2213.
- ↑ 5.0 5.1 5.2 5.3 Kim, C. and Ferrera, S. (eds.) (2010) Gestational Diabetes During and After Pregnancy, London: Springer-Verlag.
- ↑ 6.0 6.1 HAPO Study Cooperative Research Group (2009) 'Hyperglycaemia and Pregnancy Outcome Study: Associations with neonatal anthropometrics', Diabetes, 58, 453-459.
- ↑ 7.0 7.1 7.2 Catalano, P.M., Kirwen, T.P., Hougel-de Mouzon, S., King, J. (2003) 'Gestational Diabetes and Insulin Resistance: rolein short- and long-term implications for mother and fetus', J Nutr, 133, 1674S-1683S.
- ↑ Hillier, T.A., Pedula, K.L., Schmidt, M.M., Mullen, J.A., Charles, M., Pettit, D.J. (2007) 'Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycaemia', Diabetes Care, 30, 2287-2292.
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedp5
