ABSTRACT
Introduction 393 Pathophysiology 393 Screening and diagnosis 393 Overview of management 394 Implications of gestational diabetes mellitus for
future vascular health 395
Long-term follow-up of women with past gestational diabetes mellitus 399
References 400
Gestational diabetes mellitus (GDM), defined as glucose intolerance recognized for the first time during pregnancy and normally resolving after pregnancy, may result in pregnancy complications such as fetal macrosomia, shoulder dystocia, and operative delivery. It is increasingly recognized that a diagnosis of GDM is also associated with long-term health risks for the mother and child, which include increased risk of type 2 diabetes and other vascular risk factors later in life. The link between GDM and vascular disease is best understood by considering that the metabolic changes that are required to support a growing fetus lead to increasing demands on the maternal metabolic and cardiovascular systems. The increased demand can unmask underlying malfunction in these systems, such that pregnancy can be considered a metabolic ‘stress test’ for the mother.1 Thus a diagnosis of GDM might be considered a ‘failed’ stress test that is a marker of susceptibility to disease later in life. This chapter will provide an overview of clinical aspects of GDM, with a primary focus on its long-term implications for vascular health in affected women.
