20. Gestational Diabetes Mellitus

  1. John T. Queenan MD2,
  2. Catherine Y. Spong MD3 and
  3. Charles J. Lockwood MD4
  1. Deborah L. Conway MD

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch20

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Conway, D. L. (2012) Gestational Diabetes Mellitus, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch20

Editor Information

  1. 2

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 3

    Bethesda, MD, USA

  3. 4

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. Department of Obstetrics and Gynecology, University of Texas School of Medicine, San Antonio, TX, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • gestational diabetes mellitus (GDM);
  • GDM, state of carbohydrate intolerance in pregnancy;
  • diabetes screening in pregnancy;
  • GDM, and guidelines for diagnostic algorithms;
  • criteria for avoiding laboratory screening for GDM;
  • therapeutic modalities, in gestational diabetes;
  • exercise, key component in diabetes care;
  • antepartum care in pregestational diabetes;
  • timing of delivery, delicate balance complicated by diabetes;
  • glucose tolerance, reassessed in postpartum period

Summary

Normal pregnancy is a state of insulin resistance. To spare glucose for the developing fetus, the placenta produces several hormones that antagonize maternal insulin, shifting the principal energy source from glucose to ketones and free fatty acids. Most pregnant women maintain normal blood glucose levels despite the increased insulin resistance through enhanced insulin production and release by the pancreas, both in the basal state and in response to meals. Gestational diabetes mellitus is a state of carbohydrate intolerance that develops or is first recognized during pregnancy. In some women, β-cell production of insulin cannot keep pace with the resistance to insulin produced by the diabetogenic hormones from the placenta. The prevalence of gestational diabetes mellitus in the USA is 2–5%, and is proportional to the prevalence of type 2 diabetes in the population under examination, because they share a similar pathophysiology. The prevalence of gestational diabetes mellitus, along with the prevalence of type 2 diabetes, appears to be increasing. It is the most common medical complication of pregnancy and is clearly linked to several maternal and fetal complications including fetal macrosomia with operative delivery and birth trauma, preeclampsia and hypertensive disorders, metabolic complications in the neonate including hypoglycemia, hypocalcemia, and hyperbilirubinemia, prematurity, and perinatal mortality.