Gestational Diabetes Mellitus-From Risk Factors to Prevention

Abstract

Gestational diabetes mellitus (GDM) is the most common pregnancy complication globally. GDM prevalence ranges from <3% to >20%.  One in 5 livebirths is affected by hyperglycemia in pregnancy (HIP), and 1 in 6 is explicitly affected by GDM. HIP is classified as pregestational diabetes, gestational diabetes, and diabetes in pregnancy. 75%-90% of HIP cases are GDM.  Diverse environmental, socioeconomic, and individual risks play a pivotal role in the global rise in GDM. Environmental risks affect the gut microbiome, causing oxidative stress, inflammation, insulin resistance, neurohormonal/β-cell dysfunction, and genetic/epigenetic modification. These factors are associated with an increased risk of GDM and its short-term/long-term com-plications. A “neglected pollutant” (artificial light/noise) causes significant damage to women’s health. Light pollution (screen light, streetlights, artificial light at night) causes circadian rhythm and sleep disorders that lead to GDM. Mothers with low socio-economic status (an index assess-ing educational level and employment) have an increased risk of GDM. There is a wide range of individual risks – reversible (obesity, passive lifestyle, unhealthy diet, smoking, stress, etc) and irreversible (maternal age, family history of DM/GDM, miscarriages/stillbirth in previous pregnancies, etc). The more risk factors a woman has, the higher her risk of GDM. Undiagnosed/untreated GDM is associated with a wide range of maternal complications during pregnancy, labor, postpartum, and beyond, and fetal congenital/neonatal complications. Though GDM is not preventable, its risk can be lowered – the ideal time to influence GDM risks is around pregnancy. Elimination of reversible risks is essential to halt the global rise of GDM.  Its screening, treatment, and management reduce feto-maternal morbidity/mortality.