Article

Gestational Diabetes and the incidence of T2DM: A systematic review

Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
Diabetes Care (Impact Factor: 8.42). 11/2002; 25(10):1862-8. DOI: 10.2337/diacare.25.10.1862
Source: PubMed

ABSTRACT

To examine factors associated with variation in the risk for type 2 diabetes in women with prior gestational diabetes mellitus (GDM).
We conducted a systematic literature review of articles published between January 1965 and August 2001, in which subjects underwent testing for GDM and then testing for type 2 diabetes after delivery. We abstracted diagnostic criteria for GDM and type 2 diabetes, cumulative incidence of type 2 diabetes, and factors that predicted incidence of type 2 diabetes.
A total of 28 studies were examined. After the index pregnancy, the cumulative incidence of diabetes ranged from 2.6% to over 70% in studies that examined women 6 weeks postpartum to 28 years postpartum. Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow-up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM. Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes.
Conversion of GDM to type 2 diabetes varies with the length of follow-up and cohort retention. Adjustment for these differences reveals rapid increases in the cumulative incidence occurring in the first 5 years after delivery for different racial groups. Targeting women with elevated fasting glucose levels during pregnancy may prove to have the greatest effect for the effort required.

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Available from: Katherine M Newton, Jul 17, 2014
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    • "Maternal consequences associated with GDM include an increased risk of cesarean delivery, postpartum hemorrhage, and vaginal lacera- tion[20]due to a large baby and pregnancy-induced hypertension and preeclampsia[26]. Perhaps the most important impact of GDM on the mother is that there is at least a seven-fold increased risk of developing type 2 diabetes[27]that will become manifest within 5 to 10 years[28]. It is suggested that the β-cell dysfunction persists after the GDM pregnancy and that excessive maternal weight gain and retention of that excessive weight are strong contributors to long-term metabolic dysfunction[25]. "
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    ABSTRACT: Pregnancy is characterized by physiological, endocrine and metabolic adaptations creating a pseudo-diabetogenic state of progressive insulin resistance. These adaptations occur to sustain continuous fetal requirements for nutrients and oxygen. Insulin resistance develops at the level of the skeletal muscle, and maternal exercise, especially activity involving large muscle groups improve glucose tolerance and insulin sensitivity. We discuss the maternal hormonal and metabolic changes associated with a normal pregnancy, the metabolic dysregulation that may occur leading to gestational diabetes mellitus (GDM), and the consequences to mother and fetus. We will then examine the acute and chronic (training) responses to exercise in the non-pregnant state and relate these alterations to maternal exercise in a low-risk pregnancy, how exercise can be used to regulate glucose tolerance in women at risk for or diagnosed with GDM. Lastly, we present key exercise guidelines to help maintain maternal glucose regulation and suggest future research directions.
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    • "It is associated with an increased incidence of preeclampsia, premature rupture of membranes, dystocia, and increased Cesarean deliveries in the mother and increased birth weights, delayed pulmonary maturation, and polyhydramnios in the fetus (Metzger et al. 2008). Patients with GDM also have an increased risk of type 2 diabetes mellitus (DM) in subsequent years (Kim et al. 2002; Clausen et al. 2008). Low-grade subchronic inflammation is associated with obesity , metabolic syndrome, and DM (Duncan and Schmidt 2006; Hummasti and Hotamisligil 2010; Luft 2013). "
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    ABSTRACT: Gestational diabetes is the most encountered metabolic disease in pregnancy and affects both the mother and fetus adversely. Low-grade subchronic inflammation is associated with gestational diabetes development. Platelets (PLT) play role in blood coagulation and inflammatory process. We aimed to compare the various platelet indices in patients with GDM and healthy pregnant controls and to determine whether PLT indices are useful in Gestational diabetes diagnosis. The present study was performed at the Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology. Statistically significant relationships with plateletcrit, mean platelet volume, and platelet distribution width and patients with GDM were found (p < 0.001). Plateletcrit had higher sensitivity and specificity than other platelet indices. Although plateletcrit is a largely unknown or an underestimated parameter in complete blood count, it gives more precise information than platelet count and mean platelet volume. Platelet-related indices and their determination are inexpensive and routinely ordered markers, the significance of which is often ignored. They may be useful in screening for gestational diabetes as an adjunct to oral glucose tolerance test.
    Full-text · Article · Jan 2016 · Journal of Obstetrics and Gynaecology
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    • "It is associated with an increased incidence of preeclampsia, premature rupture of membranes, dystocia, and increased Cesarean deliveries in the mother and increased birth weights, delayed pulmonary maturation, and polyhydramnios in the fetus (Metzger et al. 2008). Patients with GDM also have an increased risk of type 2 diabetes mellitus (DM) in subsequent years (Kim et al. 2002; Clausen et al. 2008). Low-grade subchronic inflammation is associated with obesity , metabolic syndrome, and DM (Duncan and Schmidt 2006; Hummasti and Hotamisligil 2010; Luft 2013). "

    Full-text · Article · Jan 2016
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