Why gestational diabetes is no longer a temporary pregnancy problem

Gestational diabetes is becoming a major concern in maternal and child health, affecting about one in six pregnancies. It is no longer seen as a temporary pregnancy problem.

Instead, it can indicate long-term risks for type 2 diabetes for both mother and child, highlighting how health in early life, even before birth, can shape lifelong outcomes if the condition is not properly managed.

Gestational diabetes develops during pregnancy when the body becomes more resistant to insulin, the hormone that helps glucose move from the blood into cells for energy.

The placenta produces hormones to support the baby's growth, but some of these hormones can interfere with insulin's action. This forces the mother's body to produce more insulin than usual. If the pancreas cannot keep up, blood sugar rises, leading to gestational diabetes, according to the World Health Organisation (WHO).

Gestational diabetes is more likely in women who are overweight at the start of pregnancy, have a family history of type 2 diabetes, have had gestational diabetes before, or have conditions like polycystic ovary syndrome.

Older age and certain ethnic backgrounds, such as African, Hispanic, Asian, or Native American, also increase risk. While gestational diabetes may not show obvious symptoms, early detection and management are crucial because high blood sugar can affect both mother and baby.

For mothers, gestational diabetes raises the risk of high blood pressure and preeclampsia, a dangerous condition that can damage organs or require early delivery. It can also lead to larger babies, making labour more difficult and increasing the chance of cesarean delivery.

For babies, excess maternal blood sugar causes them to produce extra insulin, which can lead to overgrowth, known as macrosomia. This makes delivery more difficult and increases the risk of birth injuries.

After birth, babies may have dangerously low blood sugar, breathing difficulties, or jaundice. Later in life, these children are at higher risk of obesity and type 2 diabetes due to early exposure to high blood sugar.

Gestational diabetes is a critical time for detection, intervention, and prevention, yet public awareness remains low.

A study titled "Maternal and offspring DNA methylation in gestational diabetes: insights from the FinnGeDi cohort", published in Clinical Epigenetics, examined over 500 mothers and their newborns to see how gestational diabetes affects DNA methylation, a chemical marker that controls gene activity.

The researchers found that certain methylation marks in mothers, especially in genes like TFCP2, FAM13A, and UBE3C, were linked to gestational diabetes and influenced the babies' methylation.

This suggests that the mother's long-term biological traits affect how gestational diabetes shapes the baby's health, not just blood sugar during pregnancy. Many of these genes are linked to type 2 diabetes and obesity, showing that gestational diabetes can reflect deeper biological risks passed from mother to child.

Another study, "DNA methylation risk score for type 2 diabetes is associated with gestational diabetes", published in Cardiovascular Diabetology, investigated whether DNA methylation patterns that predict type 2 diabetes could also identify women at risk of gestational diabetes.

Using blood samples from two pregnancy cohorts, researchers found that women with higher methylation risk scores for type 2 diabetes were much more likely to develop gestational diabetes. This link remained strong even after considering age, body weight, smoking, and family history.

Other Topics To Read

• Health
• WHO
• Type 2 Diabetes
• Pregnant women
• Pregnancies
• Gestational diabetes
• blood sugar
• Why gestational diabetes is no longer a temporary pregnancy problem
• Headlines

The study also found that some of the same DNA sites linked to type 2 diabetes were associated with gestational diabetes, suggesting a shared biological pathway. These findings show that gestational diabetes can be an early sign of underlying vulnerabilities that may later lead to type 2 diabetes.

Epigenetic profiling could help identify high-risk women even before pregnancy, opening the door to early prevention.

The WHO has released its first global guidelines for managing diabetes during pregnancy, which affects about 21 million women each year. The guidelines aim to prevent serious complications for both mothers and babies.

If not managed, diabetes in pregnancy increases the risk of preeclampsia, stillbirth, birth injuries and other cardiometabolic diseases, especially in low- and middle-income countries with limited access to care.

"WHO has long had guidance on diabetes and guidance on pregnancy, but this is the first time we have issued a specific standard of care for managing diabetes during pregnancy," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

"These guidelines are grounded in the realities of women's lives and health needs, and provide clear, evidence-based strategies to deliver high-quality care for every woman, everywhere."

The 27 recommendations focus on personalised care, regular blood sugar monitoring, tailored treatment plans, and multidisciplinary support. They aim to integrate diabetes care into routine prenatal services and ensure all women have access to essential medicines and technology.

In Kenya, according to a study at Kenyatta National Hospital, about 11.6 per cent of pregnant women screened with the WHO oral glucose tolerance test were diagnosed with gestational diabetes.

Another more recent study using a glucose challenge test found a similar proportion, 21.5 per cent of pregnant women in its sample had gestational diabetes.

Meanwhile, research from the hospital also shows that 89.1 per cent of women with gestational diabetes had poor blood sugar control in late pregnancy, which is linked to more complications.

A study in Kenya also noted that while many pregnant women have limited knowledge about gestational diabetes, they show positive attitudes and decent practices when educated, pointing to a need for better awareness.

In sub‑Saharan Africa, prevalence estimates vary widely. A meta‑analysis of 23 studies found a pooled gestational diabetes prevalence of 14.28 per cent in the region. Another 10-year review covering 30,000+ women put the sub‑Saharan Africa prevalence closer to 3.05 per cent, indicating that rates depend heavily on how and where gestational diabetes is measured.