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Gestational Diabetes

Rana Malek MD, Mizuho Morrison, DO, and Neda Frayha, MD
00:00
16:07

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Although we typically think of gestational diabetes as an obstetric diagnosis, it has implications that can affect a woman even after her delivery. Miz and Neda sit down with Dr. Rana Malek to discuss gestational diabetes and what we need to know as primary care clinicians.  

Pearls:

  • For women with GDM, up to 70% will develop diabetes in 15 years and have an increased lifetime risk of cardiovascular disease.

  • All women with GDM should have a 75g oral glucose tolerance test 6-12 weeks postpartum and should continue to be screened for diabetes every 1-3 years.

 

  • Background:

    • Definition - diabetes diagnosed in second half (>20 weeks) of pregnancy to distinguish between pre-existing diabetes (diagnosed or undiagnosed)

    • 9% of pregnancies affected by gestational diabetes (GDM)

    • 30-70% of women with GDM will develop diabetes after 15 years of index case

    • Cardiovascular risk:

      • Women with GDM had a much higher risk of having metabolic syndrome, younger age of diagnosis of coronary artery disease and derangements of other markers of cardiovascular disease, independent of age, weight and diabetes

      • CARDIA study: GDM associated with increased carotid intima media thickness and worse left ventricular dysfunction (earliest pre-clinical manifestation of diabetic cardiomyopathy)

  • Care for women who had gestational diabetes:

    • 75g oral glucose tolerance test 6-12 weeks postpartum

    • Continue to screen every 1-3 years

    • Modify cardiovascular risk (diet, smoking, weight, physical activity, blood pressure)

      • Metformin for women with prediabetes who had gestational diabetes

 

REFERENCE:

  1. Ratner RE, Christophi CA, Metzger BE, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008;93(12):4774–4779. doi:10.1210/jc.2008-0772

  2. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update. Circulation. 2011;123(11):1243-1262. doi:10.1161/cir.0b013e31820faaf8

  3. Appiah D, Schreiner PJ, Gunderson EP, et al. Association of Gestational Diabetes Mellitus With Left Ventricular Structure and Function: The CARDIA Study. Diabetes Care. 2016;39(3):400-407. doi:10.2337/dc15-1759

  4. Gunderson EP, Chiang V, Pletcher MJ, et al. History of gestational diabetes mellitus and future risk of atherosclerosis in mid-life: the Coronary Artery Risk Development in Young Adults study. J Am Heart Assoc. 2014;3(2):e000490. Published 2014 Mar 12. doi:10.1161/JAHA.113.000490

  5. Heitritter SM, Solomon CG, Mitchell GF, Skali-Ounis N, Seely EW. Subclinical Inflammation and Vascular Dysfunction in Women with Previous Gestational Diabetes Mellitus. J Clin Endocrinol Metab. 2005;90(7):3983-3988. doi:10.1210/jc.2004-2494

  6. Carr DB, Utzschneider KM, Hull RL, et al. Gestational Diabetes Mellitus Increases the Risk of Cardiovascular Disease in Women With a Family History of Type 2 Diabetes. Diabetes Care. 2006;29(9):2078-2083. doi:10.2337/dc05-2482

  7. Xiang AH, Li BH, Black MH, et al. Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus. Diabetologia. 2011;54(12):3016-3021. doi:10.1007/s00125-011-2330-2

Kim C, Newton KM, Knopp RH. Gestational Diabetes and the Incidence of Type 2 Diabetes: A systematic review. Diabetes Care. 2002;25(10):1862-1868. doi:10.2337/diacare.25.10.1862

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Primary Care RAP December 2019 Written Summary 3 MB - PDF

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