Gestational diabetes and its complications
Monday, 06 February 2012
A study has recent demonstrated that the risk of birth defects, such as congenital heart disease and spina bifida, increases four-fold if the pregnant mother has diabetes. This study analysed data from more than 400,000 pregnancies in the north-east of England. Peri-conception glycaemia was shown to be the most important modifiable risk factor for congenital anomaly in women with diabetes.
Although this study assessed women who were known to be diabetic there are risks with gestational diabetes. Gestational diabetes mellitus (GDM) is the most common medical condition complicating pregnancy and its incidence is rising in the UK. The current incidence of GDM in the UK is around 3.5%. Patients with GDM have an increased risk of developing diabetes later in life by at least seven-fold.
GDM is known to be associated with an increased risk of other abnormalities including macrosomia, neonatal hypoglycaemia, neonatal jaundice, respiratory distress and stillbirths.
However, the diagnosis of gestational diabetes is confusing as there are currently different diagnostic criteria used for its diagnosis. The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends a 75g OGTT for all women who are not known to be diabetic at 24-28 weeks of gestation. They have predicted that using their diagnostic criteria will increase the per pregnancy incidence of GDM to over 16%.
However, NICE currently recommends that women with any one of certain risk factors should be offered testing for gestational diabetes by an OGTT at 24-28 weeks. Around 30-50% of pregnant women in the UK actually have at least one of these risk factors.
Treatment of gestational diabetes improves both pregnancy and serious perinatal outcomes. It is very important that we diagnose and treat GDM promptly and effectively to reduce the risk of these complications occurring. Women with diabetes should be educated to try and improve their glycaemic control prior to conceiving.
It has been suggested by some experts that public health efforts to reduce prepregnancy BMI by promoting physical activity and healthy eating among women of reproductive age should be intensified.