Gestational Diabetes Mellitus: Are We on the Right Track?

Abstract

Gestational Diabetes Mellitus (GDM) is a condition characterized by elevated blood glucose levels first time detected during pregnancy. Despite global advancements in screening and management, its incidence continues to rise. This review explores the causes behind this trend, outlines current diagnostic and management approaches, and emphasizes the importance of lifestyle modification, public health awareness, and coordinated care in preventing GDM and its complications.

Introduction

Gestational Diabetes Mellitus (GDM) refers to glucose intolerance first recognized during pregnancy, typically resulting from hormonal changes that cause insulin resistance. This condition differs from pre-existing diabetes mellitus (type I or II), where elevated glucose levels are present prior to conception.

The incidence of GDM has risen significantly worldwide over the past decades. Understanding the underlying causes and reinforcing effective prevention strategies are essential to reduce its impact on both maternal and fetal health.

Why Is GDM Increasing?

Several factors contribute to the global rise in GDM cases:

• Dietary Shifts and Obesity: The growing consumption of ultra-processed foods rich in refined carbohydrates and fats, combined with sedentary lifestyles, has led to higher rates of obesity and insulin resistance among women during childbearing age.
• Delayed Motherhood: More women are choosing to conceive after the age of 35, a demographic group naturally predisposed to insulin resistance and metabolic disturbances.
• Improved Detection and Screening: Enhanced antenatal care programs, better diagnostic tools, and increased awareness among healthcare providers have led to higher detection rates, though the underlying incidence also continues to climb.

Despite improved screening and management, prevention strategies have not yet effectively curbed the rising trend.

One of the reasons of this failure is the rising Food Industry, which becomes one of  the biggest industries all over the world in the 21^st century, providing cheap attractive unhealthy frozen meals wrapped in plastic containers with many conservatives.

What makes things worse is the huge number of cheerful advertisements made by celebrities encouraging consumption of unhealthy food without any warning about its harmful effects on our health. This kind of advertisements establish in our brains that such food is the source of happiness and rewards to our stress.

Again, the wide spread food delivery systems and networks to distribute food very fast while we are sitting at home playing games and watching social media is a very big challenge to any initiative to improve our physical fitness.

Diagnosis

Early screening during the first antenatal visit is crucial. Women with risk factors such as a family history of diabetes, previous GDM, or delivery of a large baby should receive close monitoring.

Normal fasting blood glucose in early pregnancy should be below 92 mg/dL. Between 24–28 weeks, a 75g oral glucose tolerance test (OGTT) is performed with the following diagnostic thresholds:

• Fasting: <92 mg/dL
• 1 hour: <180 mg/dL
• 2 hours: <153 mg/dL

While HbA1C has limited diagnostic value in pregnancy, it is useful for monitoring long-term glucose control. And reflects the average blood glucose over the past 2-3 months

HBA1C equals to or more than 6.5 reflects pre-existing DM, while value between 5.7-6.4 indicates prediabetic status and an indicator of increased risk to develop DM.

Why GDM Matters

Uncontrolled GDM poses significant risks for both mother and baby. Elevated maternal glucose can lead to fetal macrosomia (large baby), which increases the likelihood of difficult labor, cesarean delivery, and birth trauma.  For the newborn, risks include hypoglycemia, respiratory distress, and higher chances of developing obesity or type II diabetes later in life. For mothers, GDM increases the risk of preeclampsia, cesarean section, and long-term diabetes.

Management and Prevention

Effective management of GDM relies on a multidisciplinary approach, involving obstetricians, endocrinologists, dietitians, and health educators.

Respect, Confidentiality Informed consent Shared decision making, disclosure of medical errors and ensuring continuity of care and proper health education are key considerations for patient Preferences when dealing with pregnant woman with GDM.

1. Lifestyle Modification

The cornerstone of prevention and treatment is dietary control and physical activity. Replace refined carbohydrates and sugary foods with complex carbohydrates, whole grains, and vegetables. Include lean proteins and healthy fats in balanced portions.

Maintain a calorie-controlled diet guided by body mass index (BMI) and supervised by a dietitian. Engage in at least 150 minutes of moderate physical activity per week, such as walking or swimming.

2. Monitoring

Regular self-monitoring of blood glucose helps maintain:

• Fasting glucose <95 mg/dL
• 1-hour post-meal <140 mg/dL
• 2-hour post-meal <120 mg/dL

3. Medical Therapy

If lifestyle interventions are insufficient, Metformin is the first-line oral medication. It is generally safe during pregnancy, although it crosses the placenta. Insulin therapy may be initiated if optimal glucose control cannot be achieved through diet and oral medication.

4. Fetal Surveillance

Ultrasound monitoring from 28–32 weeks is essential to track fetal growth and detect complications such as macrosomia or polyhydramnios. Blood pressure and maternal well-being must be closely observed.

Timing and Mode of Delivery

Women with well-controlled GDM and no complications may deliver up to 40 weeks + 6 days. Induction of labor is considered at 37 weeks for poor glycemic control or abnormal growth scans.

Cesarean section is reserved for cases with estimated fetal weight ≥4500 g or other obstetric indications. During labor, Metformin should be withheld, and insulin therapy adjusted as needed under close supervision.

Postpartum Care

Newborns require immediate monitoring for hypoglycemia. For mothers, glucose testing is recommended 4–12 weeks postpartum using a 75g OGTT, followed by annual screening with HbA1C or fasting glucose.

Women with prior GDM have a 35–50% chance of recurrence in future pregnancies and an increased risk of developing type II diabetes.

Breastfeeding is strongly encouraged as it benefits both mother and infant by improving glucose metabolism and reducing obesity risk.

Conclusion

Gestational Diabetes Mellitus remains a major public health challenge despite advances in care. While early diagnosis and effective management reduce complications, true progress depends on preventive strategies, promoting healthy diets, physical activity, and public awareness.

Healthcare systems must work collectively to educate women, regulate food marketing, and foster environments that support healthy lifestyles before and during pregnancy. Ultimately, addressing GDM requires not only medical treatment but also social and cultural shifts toward better nutrition and active living.