Diabetes Mellitus in Pregnancy

Definition of Diabetes Mellitus in Pregestational and Gestational Contexts

• Pregestational Diabetes Mellitus (DM): Chronic metabolic disorder existing prior to pregnancy, primarily affecting carbohydrate metabolism.

• Characterized by hyperglycemia, which results from:

  • Limited insulin release in response to carbohydrate intake.
  • Impaired cellular response to insulin.

• May also disrupt fat and protein metabolic processes.

• Gestational Diabetes Mellitus (GDM): Diabetes first identified during pregnancy.

Etiological Risk Factors for Gestational Diabetes Mellitus

• Personal Characteristics:

  • Age: Increased risk for individuals aged 35 years or older, particularly with a family history (FH) of diabetes.
  • Family History: Significant risk if one has an identical twin with diabetes.
  • Obesity: Body weight exceeding 110% of ideal body weight or BMI greater than 30 kg/m² increases risk, especially with parental diabetes history.

• Obstetric Conditions:

  • Grand Multiparity: Having five or more deliveries.
  • Previous Gestational Diabetes: History of impaired glucose tolerance or GDM in earlier pregnancies is a strong risk factor.
  • Macrosomic Delivery: Having delivered a baby weighing 4 kg or more previously.
  • Repeated Abortions: History of multiple pregnancy losses.
  • Excessive Gestational Weight Gain: Risk increases with significant weight gain during pregnancy.
  • Glycosuria: Presence of glucose in urine noted during the first antenatal visit.

• Others:

  • Unexplained Intrauterine Fetal Death (IUFD) and perinatal loss.
  • Birth of a baby with Congenital Malformations of Unknown Cause (CFMF).
  • Unexplained polyhydramnios (excess amniotic fluid).