ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Matern Fetal Neonatal Med. 2017 Oct 16:1-8

Gestational diabetes mellitus (GDM) is one of the common metabolic diseases during pregnancy, affecting ~14% of all pregnancies. Better recognition of the risk factors of GDM, combined with more universal screening for the disease in many countries, has led to the increased detection of GDM along with other forms of pregestational diabetes. There is growing evidence that GDM increases the risk of several short- and long-term adverse consequences for the fetus and mother, the most significant of which is a predisposition to the metabolic syndrome and Type 2 diabetes. Maternal and childhood obesity as well as cardiovascular disease are also potential long-term consequences of GDM. Studies have suggested defects in insulin sensitivity and insulin secretion even in the absence of impaired glucose tolerance in adult offspring. In animal models, exposure to a hyperglycemic intrauterine environment also leads to the impairment of glucose tolerance in the adult offspring. These metabolic abnormalities can be transmitted to the next generation, suggesting that in utero exposure to maternal diabetes has an epigenetic impact. At the cellular level, there is impairement in pancreatic beta-cell mass and function. Several mechanisms such as defects in pancreatic angiogenesis and innervation, or modification of parental imprinting, may be implicated, acting either independently or in combination. Although the exact mechanism by which GDM increases the risk of obesity and diabetes in offspring is poorly understood, recent studies indicate that placentas exposed to maternal GDM have modified patterns of DNA methylation in the leptin and adiponectin genes. Future randomized trials will help to determine if early intervention could decrease the risk for gestational diabetes and whether long term adverse outcome are preventable and importantly the association with degree of maternal hyperglycemia in pregnancy and future morbidity.