EDITORIAL September 08, 2022 September 08, 2022

Rethinking gestational diabetes: hyperglycemia or a cluster of cardiometabolic abnormalities manifested during pregnancy?

DOI: 10.20945/2359-3997000000519

Until the last century, diabetes and pregnancy did not materialize as clinical issues because women with type 1 diabetes almost inevitably died before getting pregnant, and women with type 2 diabetes during reproductive ages barely existed. The first report of diabetes in pregnancy, published in 1823, described a case of extreme fetal macrosomia, possibly related to diabetes. The following century accumulated more experience, and the belief that diabetes could, in some cases, be a “symptom” of pregnancy led to the concept of gestational diabetes (GDM) ().

Decades of research after the 1950s have shown considerable implications of GDM in and beyond pregnancy. The iconic studies establishing diagnostic criteria for GDM during pregnancy used the incidence of future type 2 diabetes for validation (). Based on this definition, rates of GDM during pregnancy and rates of glucose intolerance in non-pregnant states were remarkably similar, supporting the notion that GDM represents the discovery of a preexisting glucose intolerance (). Currently, GDM is diagnosed based on pregnancy adverse outcomes, including large for gestational age, macrosomia, hypertensive disorders, cesarian section, and shoulder dystocia (,). Using these new criteria, GDM has become the most frequent clinical condition detected during prenatal care.

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