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Gestational Diabetes

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Gestational Diabetes

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The Lancet Series on Gestational Diabetes

Gestational Diabetes Mellitus (GDM) is the most common medical pregnancy complication
worldwide. Early diagnosis and treatment of GDM is greatly needed to improve the health of
both woman and child.

The current state

14% of pregnancies are


affected by GDM
Estimated GDM cost in the US and
China largely due to complications
Historically, GDM is tested for and treated
late into the second or third trimester

1st

2nd

US$ 1.6
billion 3rd
US$ 5.5
billion 24-28
weeks

30- 70%* of women with GDM experience hyperglycaemia from early pregnancy
(<20 weeks’ gestation, early GDM) and these pregnancies have worse outcomes for
woman and child compared to women diagnosed with late GDM
*depending on population and screening method

What this entails


Recent evidence suggests that GDM can have foundations prior to pregnancy and its effects extend
after pregnancy and through the life course for both woman and child. Early GDM treatment can
reduce pregnancy complications.

Woman Child

• Preterm delivery • Stillbirth


At delivery or neonatal period

• Hypertensive disorders of • Birth trauma (fractures, nerve palsy)


During pregnancy

pregnancy • Higher fat mass/adiposity


• Cesarean sections • Macrosomia/large-for-gestational-age infants
• Shoulder dystocia • Neonatal hypoglycaemia
• Perineal tears • Neonatal jaundice, polycythaemia
• Mental health issues • Neonatal respiratory distress
• Oral health issues • Neonatal intensive/special care unit admission

• Reduced breastfeeding uptake • Glucose intolerance


After pregnancy

• Type 2 diabetes • Overweight/obesity


Life course

• Metabolic syndrome • Increased adiposity


• Cardiovascular disease • Metabolic syndrome
• Heart failure • Elevated blood pressure
• Non-alcoholic fatty liver disease • Neurodevelopmental impairment
Image credit: JGI/Tom Grill, Adam Gault

Treatment of GDM
Gestational diabetes treatment is similar globally and is based on: The treatment of GDM diagnosed at
24-28 weeks’ gestation is associated with:

Absolute reduction of primary


5·3%
caesarean delivery

Absolute reduction of
1·3%
Maternal Physical Self-monitoring Weight Nutrition shoulder dystocia
education activity of blood management
glucose 8·9% Absolute macrosomia reduction
(where available)

Absolute reduction of neonatal


2·0%
intensive care unit admission
If these are insufficient to manage glucose
concentrations, then insulin and/or
Reduced risk of birth injury
metformin treatment are introduced

With up to 31% of type 2 diabetes in parous women attributable to GDM, there is a critical opportunity to
nearly halve this risk through lifestyle interventions, identifying strategies for prevention, diagnosis,
treatment, and long-term follow-up

Early GDM testing of those with risk Improve antenatal care that includes More research into GDM and how
factors ideally before 14 weeks gestation postpartum screening for glycemic status to improve outcomes of women
with GDM and their children across
Promoting health that prepares women, Tailored annual assessments in women
the life course.
especially those with risk factors for a with prior GDM to prevent or better manage
healthy pregnancy and, after that, for complications such as type 2 diabetes and
healthy aging cardiovascular disease

Read the full Lancet Series on Gestational Diabetes at thelancet.com

The Lancet Series on Gestational Diabetes. The Lancet 2024. Published online June 20.
www.thelancet.com/series/gestational-diabetes

Speciality title name xxxx The best science for better lives

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