Gestational diabetes mellitus (GDM) is glucose intolerance that is first recognised during pregnancy, arising when maternal insulin secretion cannot meet the increased insulin resistance induced by placental hormones, typically emerging in the second or third trimester. It is one of the most common metabolic complic…
Gestational diabetes mellitus (GDM) is glucose intolerance that is first recognised during pregnancy, arising when maternal insulin secretion cannot meet the increased insulin resistance induced by placental hormones, typically emerging in the second or third trimester. It is one of the most common metabolic complications of pregnancy and is identified through glucose screening and oral glucose tolerance testing. Recognised risk factors include older maternal age, obesity, a family history of diabetes, previous GDM or macrosomia, and certain ethnic backgrounds, and altered inflammatory signalling, including raised proinflammatory cytokines such as IL-6, TNF-alpha, and IL-1beta, has been associated with the condition. Inadequately controlled GDM increases the risk of adverse outcomes for both mother and infant, including macrosomia, operative and caesarean delivery, neonatal hypoglycaemia, pre-eclampsia, and longer-term predisposition to type 2 diabetes in the mother and metabolic risk in the child. Management is structured and stepwise, beginning with medical nutrition therapy and physical activity, with self-monitoring of blood glucose, and adding oral hypoglycaemic agents or insulin when glycaemic targets are not met. Close obstetric surveillance, attention to perioperative care including prevention of surgical-site infection after caesarean section, and postpartum reassessment of glucose status are integral, reflecting the goal of optimising immediate pregnancy outcomes and longer-term maternal and offspring health.
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