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  • Review Article
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Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 552–558 (2008)Cite this article

Abstract

Gestational diabetes mellitus (GDM) affects approximately 4% of all pregnant women in the US and represents 90% of all cases of diabetes mellitus diagnosed during pregnancy. In addition to the adverse pregnancy outcomes associated with this complication, a history of GDM predisposes women to the future development of type 2 diabetes mellitus (T2DM). Incidence rates of GDM are increasing in the US. As a consequence, a growing number of women are now at increased risk for T2DM. Opportunities to diagnose and prevent T2DM in women with a history of GDM include early diagnosis by postpartum screening and implementation of diabetes prevention measures. In this Review, we discuss current guidelines for postpartum screening, how they might be implemented, and who should take responsibility for screening individuals at risk of T2DM. In addition, we describe measures to prevent the onset of T2DM in women with a history of GDM, focusing on lifestyle modifications, such as diet and breast-feeding.

Key Points

  • Gestational diabetes mellitus is increasing in prevalence, paralleling the trends in obesity and type 2 diabetes mellitus

  • Gestational diabetes mellitus places women at increased risk for the postpartum development of type 2 diabetes mellitus

  • Screening for type 2 diabetes mellitus is recommended to be performed at the 6-week postpartum visit, with additional surveillance testing at regular intervals depending on the risk assessment

  • Lifestyle modifications, such as a healthy diet, physical activity and breast-feeding, might serve to reduce, and potentially prevent, progression to type 2 diabetes mellitus

  • Further study is needed to determine the efficacy of additional interventions, such as pharmacotherapy, that aim to enhance type 2 diabetes mellitus risk reduction in women with a history of gestational diabetes mellitus

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Acknowledgements

This work was supported in part by NIH grants K23RR023333 to RB-L and K24 RR018613 to EWS. Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. R Bentley-Lewis is an Instructor in Medicine and EW Seely is an Associate Professor in the Division of Endocrinology, S Levkoff is Associate Professor in the Division of Women's Health, and A Stuebe is a Clinical Fellow in the Department of Obstetrics, Diabetes and Hypertension, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.,

    Rhonda Bentley-Lewis, Sue Levkoff, Alison Stuebe & Ellen W Seely

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  1. Rhonda Bentley-Lewis
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Correspondence to Rhonda Bentley-Lewis.

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Bentley-Lewis, R., Levkoff, S., Stuebe, A. et al. Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus. Nat Rev Endocrinol 4, 552–558 (2008). https://doi.org/10.1038/ncpendmet0965

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