Pathogenesis (development of disease)
Gestational diabetes results in hyperglycemia (high blood glucose) due to insulin resistance that occurs physiologically in the second half of pregnancy (because of the diabetogenic effect of progesterone) and a concomitant insulin secretory defect. It is assumed that a reduced insulin sensitivity, which usually already existed before the beginning of pregnancy, is intensified by the changes during pregnancy.
The following factors may be indicative of gestational diabetes:
- Current glucosuria – sugar in the urine.
- Current excessive weight gain
- Current polyhydramnios – pathological amniotic fluid proliferation.
- Current fetal macrosomia – large growth of the unborn child.
- Previous gestational diabetes
- Tendency to abortions (miscarriages)
- Birth of a child ≥ 4,500 g
- Birth of a child with severe malformations
- Proven passive glucose intolerance in own medical history.
- Diabetes mellitus in first-degree family members.
- Overweight/obesity (obesity)
- Diseases that can lead to insulin resistance (reduced effectiveness of the body’s own insulin at the target organs skeletal muscle, adipose tissue and liver) (eg, PCO syndrome).
- Drugs that act on glucose metabolism.
Etiology (causes)
Biographical causes
- Genetic burden from parents, grandparents.
- Age
- Higher age of the woman giving birth
- Father > 45 years of age: 28% more often gestational diabetes.
- Geographic factors – Africa, Central America, Middle East, East Asia, South Asia.
Behavioral causes
- Nutrition
- Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
- Overweight
Causes related to disease
- Obesity (obesity)
- Depressed mood in the 1st or 3rd trimester (third trimester of pregnancy) (2-3.21-fold); patients who then actually developed gestational diabetes had a 4.62-fold increased risk of postpartum depression
Medications
- Antipsychotics (quetiapine, olanzapine) – Continuation of treatment with quetiapine or olanzapine during pregnancy could increase the risk of gestational diabetes: Quetiapine increased in frequency from 4.1% to 7.1%, and olanzapine from 4.7% to 12.0%; relative increase in risk of gestational diabetes of 28% for quetiapine and 61% for olanzapine
- Glucocorticoids
