Gestational diabetes mellitus: prevention of reproductive loss

Background. Gestational diabetes mellitus (GDM) is a condition characterized by the development of hyperglycemia in women during pregnancy due to the action of placental hormones and increased insulin resistance. Due to lack of standard screening system for a long time, the diagnosis of GDM could be made late or not at all. Objective. Evaluation of premorbid background, obstetric and gynecological history in pregnant women with GDM. Assessment of pregnancy outcomes in women with GDM and a history of reproductive loss. Methods. Retrospective analysis of 63 case histories of patients with GDM aged 25 to 44 years (mean age, 32.6±4.2 years) treated at the D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology was performed. We considered this pathology as a frequent and underdiagnosed factor that causes the development of unfavorable outcomes of pregnancy. Results. analysis of the course of GDM revealed that 70% of women were on diet therapy and 30% received insulin therapy. Also, retrospective analysis of the course of previous pregnancies without adequate carbohydrate metabolism monitoring in the same group of women was conducted. Particular attention was paid to patients with a history of reproductive loss who probably developed GDM in the past, but were not diagnosed. The presence of this disorder can be assumed by the characteristic obstetric and perinatal complications of pregnancy that occurred in such women: moderate or severe preeclampsia, polyhydramnios, fetoplacental insufficiency, threatened miscarriage, as well as premature rupture of membranes, birth injury, fetal macrosomia, fetal hypoxia, and neonatal hypoglycemia. In addition, the time and method of delivery of such women in the current pregnancy were assessed. The most common indications for a cesarean section were a large fetus or the presence of incompetent uterine scar. Also, a history of GDM may lead to the development of metabolic disorders (obesity, impaired carbohydrate metabolism) in both the mother and the child in the future. Conclusion. Thus, in order to avoid the risk of reproductive losses, women diagnosed with GDM need to be jointly managed by an obstetrician-gynecologist and an endocrinologist.

gestational diabetes mellitus, pregnancy, reproductive history, reproductive loss, diabetic fetopathy, macrosomia