Gestational Diabetes Mellitus
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Thomas A. Buchanan1 and Anny H. Xiang2
1Departments of Medicine, Obstetrics and Gynecology, and Physiology and Biophysics, and 
2Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
Address correspondence to: Thomas A. Buchanan, Room 6602 GNH, 1200 North State Street, Los Angeles, California 90089-9317, USA. Phone: (323) 226-4632; Fax: (323) 226-2796; E-mail: buchanan@usc.edu.
Published March 1, 2005

Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during third trimester of pregnancy). Gestational diabetes is caused when the body of a pregnant woman does not secrete excess insulin required during pregnancy leading to increased blood sugar levels.[1]
Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.[2]
As with diabetes mellitus in pregnancy in general, babies born to mothers with gestational diabetes are typically at increased risk of problems such as being large for gestational age (which may lead to delivery complications), low blood sugar, and jaundice. Gestational diabetes is a treatable condition and women who have adequate control of glucose levels can effectively decrease these risks.
Women with gestational diabetes are at increased risk of developing type 2 diabetes mellitus (or, very rarely, latent autoimmune diabetes or Type 1) after pregnancy, as well as having a higher incidence of pre-eclampsia and caesarean section;[3] their offspring are prone to developing childhood obesity, with type 2 diabetes later in life. Most patients are treated only with diet modification and moderate exercise but some take anti-diabetic drugs, including insulin.[3]
Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.[2]
Gestational diabetes is formally defined as "any degree of glucose intolerance with onset or first recognition during pregnancy". This definition acknowledges the possibility that patients may have previously undiagnosed diabetes mellitus, or may have developed diabetes coincidentally with pregnancy. Whether symptoms subside after pregnancy is also irrelevant to the diagnosis. [4][5]
The White classification, named after Priscilla White[6] who pioneered in research on the effect of diabetes types on perinatal outcome, is widely used to assess maternal and fetal risk. It distinguishes between gestational diabetes (type A) and diabetes that existed prior to pregnancy (pregestational diabetes). These two groups are further subdivided according to their associated risks and management.[7]
There are 2 subtypes of gestational diabetes (diabetes which began during pregnancy):
§  Type A1: abnormal oral glucose tolerance test (OGTT) but normal blood glucose levels during fasting and 2 hours after meals; diet modification is sufficient to control glucose levels
§  Type A2: abnormal OGTT compounded by abnormal glucose levels during fasting and/or after meals; additional therapy with insulin or other medications is required

Classical risk factors for developing gestational diabetes are the following:[8][9]
§  A previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, or impaired fasting glycaemia
§  A family history revealing a first degree relative with type 2 diabetes
§  Maternal age - a woman's risk factor increases as she gets older (especially for women over 35 years of age)
§  Ethnic background (those with higher risk factors include African-Americans, Afro-Caribbeans, Native Americans, Hispanics, Pacific Islanders, and people originating from South Asia)
§  Being overweight, obese or severely obese increases the risk by a factor 2.1, 3.6 and 8.6, respectively.
§  A previous pregnancy which resulted in a child with a high birth weight (>90th centile, or >4000 g (8 lbs 12.8 oz))

In addition to this, statistics show a double risk of GDM in smokers. Polycystic ovarian syndrome is also a risk factor, although relevant evidence remains controversial. Some studies have looked at more controversial potential risk factors, such as short stature. [8][10][11][12]
About 40-60% of women with GDM have no demonstrable risk factor; for this reason many advocate to screen all women. Typically women with gestational diabetes exhibit no symptoms (another reason for universal screening), but some women may demonstrate increased thirst, increased urination, fatigue, nausea and vomiting, bladder infection, and blurred vision.[13] 

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Arcia Celestica 
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