Pathophysiology Of Gestational Diabetes

Maya is pregnant with her first child and has suddenly been told she has gestational diabetes. She is horrified because although she was overweight before her pregnancy, she has shown no signs of heading towards diabetes and feels like she is far too young to develop diabetes. She intends to have a second child and is very worried about her own health and that of her child.

Maya is not wrong to be alarmed because gestational diabetes – also known as Gestational Diabetes Mellitus (GDM) or just mellitus – is a serious complication in late pregnancy. Maya needs to understand the pathophysiology of gestational diabetes. Although it is late in the day for this pregnancy, she could improve her lifestyle to minimize her chances of developing GDM in her next pregnancy. This is important because gestational diabetes could affect the child later on in life.

Meaning and definition of pathophysiology gestational diabetes

Pathophysiology refers to defective functioning of an organ or an individual due to an injury (or in this case a temporary imbalance due to an additional requirement). In gestational diabetes, the pregnant mother cannot make enough insulin during late pregnancy – that is during the second or third trimester. The fetus senses this excess amount of glucose in the blood and starts to produce insulin. It turns the excess glucose in the blood into fat.

Root cause of the pathophysiology of gestational diabetes

The increased sugar levels – called hyperglycemia – comes from an low glucose tolerance that in turn is caused by “pancreatic beta cell dysfunction” which translated for lay people means that the cells that are supposed to regulate glucose are in “server down” mode. These malfunctioning beta cells will mean that the woman would have had a background of low insulin production or insulin resistance.

Mothers at high risk for gestational diabetes

Pre-existing health conditions, age and family medical history – as one might have expected – have a huge role to play in the pathophysiology of gestational diabetes. Here are some risk factors:

• Overweight and obesity
• Advanced maternal age
• Family history of diabetes
• Too large or too small a fetus
• Polycystic ovaries system (pcos)
• Sleep disorders/ night shift

Additionally, some experts also point to a western diet as a potential risk factor for gestational diabetes, and some ethnicities are said to be more prone than others. Considering the generally sensitive attitude towards race and  ethnicity, globally, it is not surprising that the specific ethnicities are not quoted by experts.

Impact of the pathophysiology of gestational diabetes on the fetus/ on the child

This is the worst part by far. Gestational diabetes is resolved in the mother after the pregnancy. However, this is not true for the child. Before the child is even born and given a chance to make better lifestyle choices, gestational diabetes already puts them at risk for type 2 diabetes, heart disease and obesity. Additionally, gestational diabetes could cause overgrowth of the fetus or macrosomia which causes complications during delivery.

As of three years ago, scientists had placed the number of GDM affected pregnancies at about 14% to 17% globally and about 18 to 20 million cases but there were fears that this number could rise drastically due to the rising incidence of obesity. However, there are chances that a healthier lifestyle adopted by the general population amidst the pandemic could see these alarming numbers fall.

Impact of gestational diabetes on the mother

The effects of gestational diabetes on the mother and the pregnancy can be pretty alarming. They include

• Preterm birth
• Pre-eclampsia or high blood pressure
• Higher risk of type 2 diabetes later on
• Requirement for surgical delivery

Treatment and cure of the pathophysiology of gestational diabetes

Sadly, just like type 1 and type 2 diabetes, there is no cure for gestational diabetes. Maya and others planning a pregnancy are best off living a healthy lifestyle and managing their weight. Maybe “eating for two” and giving in to every sugary craving during pregnancy should be ideas that we put to considering new awareness about gestational diabetes.

Diet and exercise are at the moment the best bet with regards to preventing gestational diabetes. Insulin therapy is used, but is not always very effective because the underlying cause of gestational diabetes is insulin resistance. A new trend is antidiabetics of the oral variety but because these treatments are new, there has not been sufficient time to witness their long term effects on the mother or the child.

Can gestational diabetes only affect pregnant women and only women

Although gestational diabetes is seen most commonly during a pregnancy, it is important to remember that the word pathophysiology is defined as abnormal behaviour of an organ or an individual after “injury”. Let us give this word injury a little context with regards to gestational diabetes where it seems to mean a temporary phase where the body is more vulnerable. When you look at the word injury from this perspective it is easy to understand how the pathophysiology of gestational diabetes is also seen in:

• Patients suffering from pancreatitis
• Drug induced diabetes in the case of treatment for HIV
• Chemical and drug induced diabetes after an organ transplant

Over 3/4th of all gestational diabetes cases worldwide are pregnancy related, while the other three causes cited above are responsible for the remainder.