Gestational Diabetes Mellitus: Complications

The following are the most important diseases or complications that may be contributed to by gestational diabetes mellitus (gestational diabetes):

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

Malformation prevalences (disease incidence) of children were in mothers:

  • 0.29% without diabetes,
  • With preconceptional diabetes 0.79%,
  • With GDM 0.38 %

For example, the adjusted RRs of cyanotic congenital heart disease (eg. Tetralogy of Fallot) were 4.61 (95% CI 4.28-4.96) for gestational diabetes and 1.50 (95% CI 1.43-1.58) for GDM; the adjusted RRs of hypospadias (urethra opens on the underside of the penis) were 1.88 (95% CI 1.67-2.12) for gestational diabetes and 1.29 (95% CI 1.21-1.36) for GDM. Certain conditions originating in the perinatal period (P00-P96).

  • Respiratory disorders
  • Macrosomia (newborn with a very high birth weight) – Macrosomia is defined as a birth weight above the 95th percentile (= 4,350 g)
  • Renal vein thrombosis – occlusion of a blood vessel supplying the kidney.
  • Perinatal mortality (number of infant deaths in the perinatal period/deaths and deaths up to day 7 after birth) ↑
  • Polyglobulia – multiplication of red blood cells.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Obesity – the newborn’s risk of developing obesity later in life is increased
  • Diabetes mellitus (diabetes) – the risk is increased in both mother and child; insulin-dependent gestational diabetes leads to type 2 diabetes in 90 percent: women who had to be treated with insulin during pregnancy have the greatest risk of type 2 diabetes: almost two-thirds of this group of participants in the prospective gestational diabetes study (PINGUIN study; Postpartum Intervention in Gestational Diabetics on Insulin Therapy) developed type 2 diabetes within three years after delivery – within 15 years, it was even more than 90 percent. The prospective Gestational Diabetes Study has analyzed the development of type 2 diabetes in gestationally diabetic women for 19 years. What is new, however, is the finding that breastfeeding also prevents type 2 diabetes in the mother in the long term. This applies exclusively to those gestational diabetics in whom no autoantibodies associated with type 1 diabetes could be detected. This was true for most of the 304 participants in the study: only 32 participants had formed these autoantibodies. In them, no effect of breastfeeding on the development of diabetes postpartum was detected.
    • Breastfeeding delays type 2 diabetes by ten years: the length of breastfeeding is crucial here: only those who breastfed for longer than three months had a 15-year risk of type 2 diabetes of 42 percent. The subjects were able to reduce their risk of developing the disease even more if they fed their baby exclusively with breast milk during this period (15-year risk of 34.8 percent). Breastfeeding enabled the autoantibody-negative participants to delay the development of type 2 diabetes by an average of ten years.
    • The women who were able to manage their gestational diabetes during pregnancy with diet alone achieved the greatest preventive success through breastfeeding. This was not dependent on the body mass index (BMI) of the participants. However, the overweight women breastfed their babies earlier on average – after an average of five weeks. In contrast, the average duration of breastfeeding in the entirety of the participants was nine weeks.
  • Mediterranean diet after delivery resulted in 40% less likely to develop type 2 diabetes (hazard ratio HR 0.60; 95 percent confidence interval 0.44-0.82)
  • Risk of diabetes in the child of mothers with gestational diabetes: incidence (frequency of new cases) of diabetes mellitus was almost twice as high in children of mothers with gestational diabetes compared with children of metabolically healthy women (4.52/10,000 person-years (PY) versus 2.4/10,000 PY).
  • Diabetic ketoacidosis (DKA) – severe metabolic derailment (ketoacidosis) associated with insulin deficiency.
  • Hyperbilirubinemia* – increased blood level of the bile pigment.
  • Hypocalcemia (calcium deficiency)*
  • Hypoglycemia* (low blood sugar)
  • Hypomagnesemia* (magnesium deficiency)
  • Metabolic syndrome – the newborn’s risk of developing metabolic syndrome later in life is increased

* In the perinatal period.

Cardiovascular system (I00-I99).

  • Arterial hypertension; the risk of developing hypertension later in life is increased for:
    • Newborns
    • Mother (Incidence Rate Ratio: IRR = 1.85; 95% CI 1.59-2.16).
      • Mothers who ate a healthy balanced diet (Mediterranean diet) after delivery were 30% less likely to have hypertension (HR 0.70; 0.56-0.88)
  • Coronary artery disease (CAD, cardiovascular disease) (IRR = 2.78; 95% CI 1.37-5.66).

Infectious and parasitic diseases (A00-B99).

  • Candida infections (fungal infections), unspecified.

Ears – mastoid process (H60-H95)

Psyche – nervous system (F00-F99; G00-G99)

  • Attention-deficit/hyperactivity disorder (ADHD).
  • Postpartum depression (PPD; postpartum depression; unlike short-term “baby blues,” this carries the risk for permanent depression)

Pregnancy, childbirth, and postpartum (O00-O99).

  • Perineal laceration
  • Premature birth
  • Gestational diabetes in a new pregnancy
  • Preeclampsia – disease occurring during pregnancy, associated with the symptoms of edema (water retention in the tissues), proteinuria (increased excretion of protein in the urine) and arterial hypertension (high blood pressure).
  • Shoulder dystocia (shoulder blade malformation) as an obstacle to birth.
  • Pregnancy-induced hypertension – the occurrence of high blood pressure caused by pregnancy.
  • Severe postpartum hemorrhage – bleeding that occurs after delivery of the baby.
  • Late intrauterine fetal death (IUFT).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

  • Urinary tract infections, unspecified

Other

  • There is an increased risk of a sectio (cesarean section)