Gestational diabetes mellitus

Obstetrics and Gynegology2021№9

DOI

https://dx.doi.org/10.18565/aig.2021.9.174-179

Volkova N.I., Davidenko I.Yu., Degtyareva Yu.S.
Internal Diseases Department No. 3, Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russia

Gestational diabetes mellitus (GDM) is the most common disease complicating pregnancy. GDM is associated with the development of a number of short- and long-term complications for both the mother and the fetus; therefore it is a general medical problem. Nevertheless, there is currently no consensus on the glycemic thresholds required for diagnosis and subsequent treatment. Effective treatment in women with GDM significantly reduces the risk of perinatal complications. Maintenance of normoglycemia is mainly achieved by changing the diet, increasing physical activity, and controlling weight gain during pregnancy, but some women will also need drug treatment. One of the factors determining the efficiency of non-drug therapy and the need to initiate drug treatment in women with GDM may be directly related to the pathophysiological aspects of hyperglycemia that occurs during pregnancy, namely, to which component in the pathogenesis of GDM prevails in a given woman: insulin resistance, β-cell dysfunction, or both factors are equally expressed. The heterogeneity of the pathogenetic mechanisms underlying different GDM subtypes, which is reflected in the phenotypic signs and outcomes of pregnancy, has been demonstrated in a number of studies. The results of these studies are presented in the review and are of great importance for understanding the physiology of hyperglycemia in pregnant women, suggesting that heterogeneity in the pathogenesis of GDM affects perinatal outcomes and complications associated with hyperglycemia in pregnant women, and other characteristics of pregnant women and newborns. There are presently insufficient data to revise the approach to pregnant patients with GDM, by taking into account the predominant pathogenetic component.
Conclusion: Further study of the heterogeneity of GDM and its pathogenetic subtypes certainly deserves attention, since it is the predominance of a particular pathogenetic mechanism that can be a determining factor in choosing a diagnostic, therapeutic, and preventive approach.

gestational diabetes mellitus

insulin resistance

pancreatic β-cell dysfunction

subtypes of gestational diabetes mellitus

Full text (in Russian)

Дедов И.И., Шестакова М.В., Майоров А.Ю., ред. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 9-й выпуск. Сахарный диабет. 2019; 22 (Suppl. 1-1): 1-144. [Dedov I.I., Shestakova M.V., Mayorov A.Yu., eds. Algorithms for specialized medical care for patients with diabetes. Eds. Diabetes. 2019; 22: 135. (in Russian)]. https://dx.doi.org/10.14341/DM221S1.
McIntyre H., Catalano P., Zhang C., Desoye G., Mathiesen E., Damm P. Gestational diabetes mellitus. Nat. Rev. Dis. Primers. 2019; 5(1): 47. https://dx.doi.org/10.1038/s41572-019-0098-8.
The International Diabetes Federation. Care and prevention. Gestational diabetes. 2021. Online. Available at: <https://www.idf.org/our-activities/care-prevention/gdm> Accessed 19 March 2021.
UpToDate.com. 2021. UpToDate. Online. Available at: <https://www.uptodate.com/contents/gestational-diabetes-mellitus-obstetric-issues-and-management> Accessed 19 March 2021.
Benhalima K., Mathieu C., Damm P., Van Assche A., Devlieger R., Desoye G. et al. A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG). Diabetologia. 2015; 58(7): 1422-9. https://dx.doi.org/10.1007/s00125-015-3615-7.
Hod M., Kapur A., Sacks D., Hadar E., Agarwal M., Di Renzo G. et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int. .J Gynaecol. Obstet. 2015;131(Suppl. 3): S173-211. https://dx.doi.org/10.1016/S0020-7292(15)30033-3.
Sadikot S., Purandare C., Cho N., Hod M. FIGO-IDF joint statement and declaration on hyperglycemia in pregnancy. Diabetes Res. Clin. Pract. 2018; 145: 1-4. https://dx.doi.org/10.1016/j.diabres.2018.02.031.
Egan A., Vellinga A., Harreiter J., Simmons D., Desoye G., Corcoy R. et al. Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe. Diabetologia. 2017; 60(10): 1913-21. https://dx.doi.org/10.1007/s00125-017-4353-9.
ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet. Gynecol. 2018; 131(2): e49-64. https://dx.doi.org/10.1097/aog.0000000000002501.
Дедов И.И., Краснопольский В.И., Сухих Г.Т. Проект национального российского консенсуса «Гестационный сахарный диабет: диагностика, лечение, послеродовое наблюдение». Проблемы эндокринологии. 2013; 59(1): 23-9. [Dedov I., Krasnopol'skii V., Sukhikh G. The Project of Russian Consensus "Gestational diabetes mellitus: diagnostics, treatment, postpartum follow-up". Problems of Endocrinology. 2013; 59(1): 23-9. (in Russian)]. https://dx.doi.org/10.14341/probl201359123-29.
Nice.org.uk. 2021. Overview, Diabetes in Pregnancy: Management from preconception to the postnatal period. Guidance, NICE. Online. Available at: <https://www.nice.org.uk/guidance/ng3> Accessed 19 March 2021.
Uptodate.com. 2021. UpToDate. Online. Available at: <https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis> Accessed 19 March 2021. Cм. №4 ссылки разные
Plows J., Stanley J., Baker P., Reynolds C., Vickers M. The pathophysiology of gestational diabetes mellitus. Int. J. Mol. Sci. 2018; 19(11): 3342. https://dx.doi.org/10.3390/ijms19113342.
Di Cianni G., Miccoli R., Volpe L., Lencioni C., Del Prato S. Intermediate metabolism in normal pregnancy and in gestational diabetes. Diabetes Metab. Res. Rev. 2003; 19(4): 259-70. https://dx.doi.org/10.1002/dmrr.390.
Ashcroft F., Rohm M., Clark A., Brereton M. Is type 2 diabetes a glycogen storage disease of pancreatic β cells? Cell Metab. 2017; 26(1): 17-23. https://dx.doi.org/10.1016/j.cmet.2017.05.014.
Powe C., Allard C., Battista M., Doyon M., Bouchard L., Ecker J. et al. Heterogeneous contribution of insulin sensitivity and secretion defects to gestational diabetes mellitus: table 1. Diabetes Care. 2016; 39(6): 1052-5. https://dx.doi.org/10.2337/dc15-2672.
Liu Y., Hou W., Meng X., Zhao W., Pan J., Tang J. et al. Heterogeneity of insulin resistance and beta cell dysfunction in gestational diabetes mellitus: a prospective cohort study of perinatal outcomes. J. Transl. Med. 2018; 16(1): 289. https://dx.doi.org/ 10.1186/s12967-018-1666-5.
Feghali M., Atlass J., Ribar E., Caritis S., Simhan H., Scifres C. 82: Subtypes of gestational diabetes mellitus based on mechanisms of hyperglycemia. Am. J. Obstet. Gynecol. 2019; 220(1, Suppl.): S66. https://dx.doi.org/10.1016/j.ajog.2018.11.091.
Layton J., Powe C., Allard C., Battista M., Doyon M., Bouchard L. et al. Maternal lipid profile differs by gestational diabetes physiologic subtype. Metabolism. 2019; 91: 39-42. https://dx.doi.org/10.1016/j.metabol.2018.11.008.
Benhalima K., Van Crombrugge P., Moyson C., Verhaeghe J., Vandeginste S., Verlaenen H. et al. Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance. Diabetologia. 2019; 62(11): 2118-28. https://dx.doi.org/10.1007/s00125-019-4961-7.

Received 25.03.2021

Accepted 11.06.2021

Natalia I. Volkova, MD, PhD, Professor, Vice-Сhancellor on Scientific Research, Head of the Department of Internal Diseases №3, Rostov State Medical University,
Ministry of Health of Russia, +7(918)555-30-69, https://orcid.org/0000-0003-4874-7835, 29 Nakhichevansky Lane, Rostov-on-Don, Russia, 344022.
Ilya Y. Davidenko, MD, associate professor of the Department of Internal Medicine №3, Rostov State Medical University, Ministry of Health of Russia, +7(961)318-41-41, https://orcid.org/0000-0002-8690-681X, 29 Nakhichevansky Lane, Rostov-on-Don, Russia, 344022.
Yuliya S. Degtyareva, postgraduate student of the Department of Internal Diseases №3, Rostov State Medical University, Ministry of Health of Russia, +7(918)851-53-30, i.s.degtiareva@gmail.com, https://orcid.org/0000-0001-5838-4383, 29 Nakhichevansky Lane, Rostov-on-Don, Russia, 344022.
Corresponding author: Yuliya S. Degtyareva, i.s.degtiareva@gmail.com

Authors' contributions: Davidenko I.Yu. – concept and design of the article; editing; Degtyareva Yu.S. – search for and analysis of literature; processing of source material, writing the text; Volkova N.I. – editing and final approval of the manuscript.
Conflicts of interest: The authors declare that there are no manifest and potential conflicts of interest, which are related to the publication of this article.
Funding: The investigation has been conducted without funding from third parties.

For citation: Volkova N.I., Davidenko I.Yu., Degtyareva Yu.S. Gestational diabetes mellitus.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 9: 174-179 (in Russian)
https://dx.doi.org/10.18565/aig.2021.9.174-179

Gestational diabetes mellitus

Volkova N.I., Davidenko I.Yu., Degtyareva Yu.S.

Keywords

References

About the Authors

Similar Articles