Gestational Diabetes: Risk factors and pathogenesis
Normal metabolic changes occurring in pregnancy (e.g., increased lipid storage, increase renal filtration, increased glucose production etc.)
Authors:
Amyna Fidai
Maharshi Gandhi Reviewers:
Laura Byford-Richardson Shahab Marzoughi
Yan Yu*
Hanan Bassyouni*
* MD at time of publication
High risk population (Aboriginal, Hispanic, South Asian, Asian, African)
Previous or current macrosomia (>4000g) or polyhydramnios
Other conditions associated with Diabetes Mellitus such as polycystic ovarian syndrome, hypertension, metabolic syndrome
Placental counter regulatory hormones (particularly Human Placental Growth Hormone) oppose the action of insulin
↑ Insulin resistance (liver, muscle, adipose tissues become less responsive to insulin)
↑ Fetal demands after 18 weeks gestation
(fetus requires 80% of its energy from maternal glucose)
↑ Carbohydrate intake to keep up with the demands
Previous history of gestational diabetes or glucose intolerance
Family history of diabetes
Advanced maternal age
Obesity
Previous unexplained stillbirth
Multiples (larger placental mass and activity)
Corticosteroid use
↑ Risk for pregnancy induced glucose intolerance (mechanism unclear and/or complex)
↑ Insulin requirements Initially pancreatic beta cells work
overtime to keep up with the ↑ insulin demands
Eventually insulin demands are not met due to the exhaustion of pancreatic beta cells
Plasma glucose rises (Fasting plasma glucose ≥5.3 mmol/L)
Gestational Diabetes (or exacerbation of pre-existing DM)
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published Jan 28, 2017, updated Feb 24, 2024 on www.thecalgaryguide.com