Gestational diabetes: An invisible maternal and infant health issue

Glucose intolerance in pregnancy and diabetes are linked, both in the mothers and their children

September 7, 2016

Gestational diabetes mellitus (GDM) is a temporary condition that increases an expectant mother's risk of complications during pregnancy and childbirth.

GDM occurs when the mother's pancreas (the large gland behind the stomach) does not produce enough insulin to move glucose from the bloodstream into the body's cells. When it occurs, increased blood sugar results, which is dangerous for both mother and baby. 

According to international criteria, GDM affects up to 26% of pregnancies - depending on the ethnic background. Women that develop GDM are at higher risk of pre-eclampsia, caesarean section, and giving birth to larger than average babies. Infants born to GDM women are more likely to experience shoulder injury during delivery, and to suffer from hypoglycemia and respiratory distress at birth.

Invisible danger

Because it is often symptomless, routine screening for GDM is important in order to diagnose and manage the condition. This involves a blood sample, taken to determine glucose levels, typically during the second trimester. If those results indicate higher than normal blood glucose levels, the condition is categorized as GDM.

Changes in the mother's diet and exercise can be critical elements in helping to control GDM, but insulin treatment might also be needed. However, researchers have recently discovered that women who develop GDM are at a higher risk of developing type 2 diabetes in the years following their pregnancy, as are their children.

In the long term, women with GDM are seven times more likely to develop type 2 diabetes later on in life. Source: International Diabetes Federation

Also, exposure to GDM predisposes the child to increase fat accumulation overtime which is an important risk factor for obesity and diabetes development. Source: 2016 WHO Report on “Ending Childhood Obesity”.

Dr. Luigi Bouchard
University of Sherbrooke
Photo courtesy of Dr. Luigi Bouchard.

Over the years, CIHR has made important investments in diabetes research. The work being conducted by Dr. Luigi Bouchard, an associate professor with the Department of Biochemistry at the University of Sherbrooke, is helping to reduce the incidence of diabetes.

Dr. Bouchard and his team believe that there is sufficient evidence supporting that gestational diabetes can be transmitted from a mother to her child, pre-disposing them to developing either glucose intolerance or diabetes by pre-programming their cells.

While Dr. Bouchard's work is pioneering a new field of research (cell programming in pregnancy), it promises to shed new light on our understanding of diabetes.  It also underscores the need to educate mothers on healthy lifestyle choices, as the bond she shares with her child may have long-term consequences to their well-being. This knowledge will go a long way to reducing the occurrence of preventable GDM. 

Women with GDM must receive practical nutritional education and counselling that will empower them to choose the right quantity and quality of food and level of physical activity.

They should be advised repeatedly during pregnancy to continue the same healthy lifestyle after delivery to reduce the risk of future obesity, type 2 diabetes, and cardiovascular diseases. 

Source: International Federation of Gynecologists and Obstetricians

"Our work provided the first evidence that the newborn's epigenome – the program that controls how the genetic information is read by the cells, much like software in computers – is impacted by GDM through exposure to their mother's high blood sugar levels. Many of the impaired genes that we have found are in fact 'diabetes' genes. This suggests that cells are already pre-programmed at birth to develop diabetes. We strongly believe that knowing the disease processes is a key step in defining better prevention programs. This is why we are conducting this research program and have recently extended our work on developing improved diagnosis tools for GDM."

Dr. Luigi Bouchard

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