Gestational Diabetes Mellitus

Authors: Hana Krejčí 1,2
Authors‘ workplace: III. interní klinika 1. LF UK a VFN v Praze 1;  Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze 2
Published in: Vnitř Lék 2016; 62(Suppl 4): 52-61
Category: Reviews


The present generation of women of childbearing age more frequently suffer from overweight, obesity, initial as well as fully established metabolic syndrome, which together with postponing motherhood until the third decade in life plays an important role in the increasing incidence of gestational diabetes (GDM) that currently affects about 1/5 of pregnant women. However the causal link between diabetes during pregnancy and metabolic diseases in the whole population is mutual. By way of epigenetic changes, maternal diabetes unfavourably programmes metabolism of the offspring, who tend to transfer the disorder to the next generations. Gestational diabetes is therefore an important link fitting into the accumulation curve of the incidence of overweight, obesity, metabolic syndrome and consequently also T2DM among the whole population. Genetic as well as epigenetic factors play a great role in the GDM pathogenesis, which is shown by the fact that this complication also affects women with normal BMI. When it comes to diagnosing GDM, we will need to manage also in future with establishing fasting glycemia and glycemia following glucose challenge (OGTT) that may include a considerable degree of measurement inaccuracy. It is therefore necessary to observe pre-analytical and analytical conditions of measurements in order to obtain a reliable result. It is a positive sign that the Czech professional associations have adopted new international criteria for diagnosing GDM which, as opposed to those valid earlier, better reflect the risk of pregnancy-related and perinatal complications.

The care for gestational patients with diabetes at a low risk (due to satisfactory glycemic control through a diet or small pharmacotherapeutic doses, with an eutrophic fetus and without associated complications) is provided by an outpatient gynecologist and a diabetes specialist, they can give birth in standard maternity hospitals. The care for gestational patients with diabetes at a higher risk is taken over by specialist centres. The early and appropriate treatment of gestational diabetes demonstrably reduces the risk of complications. The base for therapy is formed by regimen-related measures: the therapeutic diet and increased physical activity. The best results of the dietary therapy are achieved with foods low on glycemic index and glycemic load that can also act as efficient prevention of GDM and subsequent development of T2DM. A small number of cases require adding of pharmacological therapy: insulin and newly also metformin. Metformin is the drug of choice primarily in obese patients, however in almost half of the cases insulin must be added. Medication, in particular with insulin, must be introduced carefully, following re-education and elimination of dietary mistakes. The aim of the treatment is not only to achieve normoglycemia, but also to improve, or at least to not further worsen insulin resistance. Insulin resistance alone without diabetes, e.g. due to obesity or a great weight gain, may lead to macrosomia and epigenetic changes. In this regard, the prevention within the whole population of pregnant women needs to be improved and the vicious circle of the causation of metabolic disorders among the population needs to be broken.

Key words:
recommended procedure – epigenetic changes – gestation diabetes mellitus – macrosomia – screening


1. WHO 2013. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Dostupné z WWW:

2. Franeková J, Jabor A. Gestační diabetes mellitus: analýza 2043 výsledků oGTT – je čas na změnu? Klin Biochem Metab 2010; 18(1): 30–37.

3. Anderlová K, Krejčí H, Klusáčková P et al. Alarmující výskyt gestačního diabetes mellitus při použití stávajících i nových mezinárodních diagnostických kritérií. Ceska Gynekol 2014; 79(3): 213–218.

4. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes. Diabetes Care 2002; 25(10): 1862–1868.

5. Huopio H, Cederberg H, Vangipurapu J et al. Association of risk variants for type 2 diabetes and hyperglycemia with gestational diabetes. Eur J Endocrinol 2013; 169(3): 291–297. Dostupné z DOI: <–0286>.

6. Wang YH, Wu HH, Ding H et al. Changes of insulin resistance and beta-cell function in women with gestational diabetes mellitus and normal pregnant women during mid- and late pregnant period; a case-control study. J Obstet Gynaecol Res 2013; 39(3): 647–652. Dostupné z DOI: <–0756.2012.02009.x>.

7. Sonagra AD, Biradar SM, Murthy DS. Normal pregnancy – a state of insulin resistance. J Clin Diagn Res 2014; 8(11): CC01-CC03. Dostupné z DOI: <>.

8. Barbour LA, McCurdy CE, Hernandez TL et al. Cellular Mechanisms for Insulin Resistance in Normal Pregnancy and Gestational Diabetes. Diabetes Care 2007; 30(Suppl 2): S112-S119. Erratum in Diabetes Care 2007; 30(12): 3154.

9. Retnakaran R, Qi Y, Sermer M et al. Pre-gravid physical activity and reduced risk of glucose intolerance in pregnancy: the role of insulin sensitivity. Clin Endocrinol (Oxf) 2009; 70(4): 615–622. Dostupné z DOI: <–2265.2008.03393.x>.

10. Zhang C, Liu S, Solomon CG et al. Dietary fiber intake, dietary glycemic load, and the risk for gestational diabetes mellitus. Diabetes Care 2006; 29(10): 2223–2230.

11. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004; 79(4): 537–543. Erratum in Am J Clin Nutr. 2004; 80(4): 1090.

12. Zhang C, Schulze MB, Solomon CG et al. A prospective study of dietary patterns, meat intake and the risk of gestational diabetes mellitus. Diabetologia 2006; 49(11): 2604–2613.

13. Luoto R, Laitinen K, Nermes M et al. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr 2010; 103(12): 1792–1799. Dostupné z DOI: <>.

14. Metzger BE, Lowe LP, Dyer AR et al. [HAPO Study Cooperative Research Group]. Hyperglycemie and Adverse Pregnancy Outcomes. N Engl J Med 2008; 358(19): 1991–2002. Dostupné z DOI: <>.

15. [HAPO Study Cooperative Research Group]. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: Associations with neonatal anthropometrics. Diabetes 2009; 58(2): 453–459. Dostupné z DOI: <–1112>.

16. Metzger BE, Gabbe SG, Persson B et al. [International Association of Diabetes and Pregnancy Study Groups Consensus Panel]. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010; 33(3): 676–682. Dostupné z DOI: <–1848>.

17. Gestační diabetes mellitus: doporučený postup. Česká Gynekol 2015; 80(5): 459–461.

18. Diabetes mellitus – laboratorní diagnostika a sledování stavu pacientů. Dostupné z WWW:

19. Nold JL, Georgieff MK. Infants of diabetic mothers. Pediatr Clin N Am 2004; 51(3): 619- 637, viii.

20. Carmichael SL, Rasmussen SA, Shaw GM. Prepregnancy obesity: A complex risk factor for selected birth defects. Birth Defects Res A Clin Mol Teratol 2010; 88(10): 804–810. Dostupné z DOI: <>.

21. Freinkel N. Banting Lecture 1980. Of pregnancy and progeny. Diabetes 1980; 29(12): 1023–1035.

22. Pinney SE, Simmons RA. Metabolic programming, epigenetics and gestational diabetes mellitus. Curr Diab Rep 2012; 12(1): 67–74. Dostupné z DOI: <–011–0248–1>.

23. Kulie T, Slattengren A, Redmer J et al. Obesity and woman’s health. An evidence-based review. J Am Board Fam Med 2011; 24(1): 75–85. Dostupné z DOI: <>.

24. Van Lieshout RJ, Voruganti LP. Diabetes mellitus during pregnancy and increased risk of schizophrenia in offspring: a review of the evidence and putative mechanisms. J Psychiatry Neurosci 2008; 33(5): 395–404.

25. Schwartz MW, Porte D Jr. Diabetes, obesity, and the brain. Science 2005; 307(5708): 375–379.

26. Crowther CA, Hiller JE, Moss JR et al. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352(24): 2477–2486.

27. Landon MB, Spong CY, Thom E et al. A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes. N Engl J Med 2009; 361(14): 1339–1348. Dostupné z DOI: <>.

28. Doporučený postup péče o diabetes mellitus v těhotenství ČDS ČLS TEP 2014. Dostupné z DOI:

29. Rizzo TA, Doodly SL, Metzger BE et al. Prenatal and perinatal influences on long-term psychomotor development in offspring of diabetic mothers. Am J Obstet Gynecol 1995; 173(6): 1753–1758.

30. Bon C, Raudrant D, Golfier F et al. Feto-maternal metabolism in human normal pregnancies: study of 73 cases. Ann Biol Clin 2007; 65(6): 609–619.

31. Viana LV, Gross JL, Azevedo MJ. Dietary intervention in patients with gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials on maternal and newborn outcomes. Diabetes Care 2014; 37(12): 3345–3355. Dostupné z DOI: <–1530>.

32. Azad MB, Sharma AK, de Souza RJ et al. Association Between Artificially Sweetened Beverage Consumption During Pregnancy and Infant Body Mass Index. JAMA Pediatr 2016; 170(7): 662–670. Dostupné z DOI: <>.

33. Klebanoff MA, Shiono PH, Carey JC. The effect of physical activity during pregnancy on preterm delivery and birth weight. Am J Obs Gyn 1990; 163(5 Pt 1): 1450–1456.

34. Holt RIG, Lambert KD. The use of oral hypoglycaemic agents in pregnancy. Diabet Med 2013; 31(3): 282–291. Dostupné z DOI: <>.

35. Nicholson W, Bolen S, Witkop CT et al. Benefits and risks of oral diabetes agents compared with insulin in women with gestational diabetes: a systematic review. Obstet Gynecol 2009; 113(1): 193–205. Dostupné z DOI: <>.

36. Černý M. Péče o donošené a lehce nezralé novorozence matek s GDM. Dostupné z WWW:

37. Taylor JS, Kacmar JE, Nothnagle M et al. A systematic review of the literature associating breastfeeding with type 2 diabetes and gestational diabetes. J Am Coll Nutr 2005; 24(5): 320–326.

38. Crofts C, Schofield G, Zinn C et al. Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract 2016; 118: 50–57. Dostupné z DOI: <>.

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