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©The Author(s) 2023.
World J Diabetes. Aug 15, 2023; 14(8): 1178-1193
Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1178
Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1178
Table 1 Variations between type 2 diabetes mellitus and gestational diabetes mellitus
Type 2 diabetes mellitus | Gestational diabetes mellitus | |
Occurrence | Generally, develops after age 40, but can occur at any age | Develops during pregnancy, typically after the 20th wk of gestation |
Prevalence | Affects approximately 90% of people with diabetes | Affects approximately 2%-10% of pregnancies |
Risk factors | Family history, obesity, physical inactivity, high blood pressure, and ethnicity | Family history, previous history of gestational diabetes, obesity, older maternal age, and certain ethnicities |
Symptoms | Fatigue, increased thirst, frequent urination, blurred vision, slow healing wounds | Often asymptomatic, but may cause increased thirst, frequent urination, and increased hunger |
Diagnosis | Blood tests measuring fasting blood glucose and hemoglobin A1C levels | Oral glucose tolerance test usually performed between 24-28 wk of gestation |
Treatment | Lifestyle changes, medication, and/or insulin therapy | Lifestyle changes, close monitoring of blood glucose levels, and medication/insulin therapy if necessary |
Potential complications | Cardiovascular disease, neuropathy, retinopathy, kidney disease, and foot ulcers | Preeclampsia, premature delivery, macrosomia, and increased risk of developing type 2 diabetes later in life |
Table 2 Risk factors for gestational diabetes mellitus
Risk factors for GDM | Description |
Increasing maternal age | Increases in gestational diabetes were seen in each maternal age group, and rates rose steadily with maternal age; in 2021, the rate for mothers aged ≥ 40 yr (15.6%) was nearly six times as high as the rate for mothers aged < 20 yr (2.7%)[16,25] |
Past medical history of GDM in a previous pregnancy OR family history of type 2 DM | The strongest risk factor for gestational diabetes mellitus, with reported recurrence rates of up to 84%[26] |
Race/ethnicities at increased risk for development of GDM | Women of Hispanic[17], other than white European origin[18], Asian[19], and indigenous descent[17-20] |
Prevalence of GDM by ethnicity | The highest prevalence using the 2000 ADA diagnostic criteria among Filipinas (10.9%) and Asians (10.2%), followed by Hispanics (6.8%), non-Hispanic Whites (4.5%), and Black Americans (4.4%)[28] |
Table 3 Gestational diabetes mellitus trends and statistics from 2016 to 2020
Year | Total births | GDM cases | GDM rate (%) | Confidence interval | Not stated cases |
2016 | 3945875 | 234847 | 6.0 | 5.9-6.0 | 3781 |
2017 | 3855500 | 244716 | 6.4 | 6.3-6.4 | 3711 |
2018 | 3791712 | 252522 | 6.7 | 6.6-6.7 | 2882 |
2019 | 3747540 | 258676 | 6.9 | 6.9-6.9 | 3284 |
2020 | 3613647 | 281789 | 7.8 | 7.8-7.8 | 4063 |
Change, % | -8.6 | +19.8 | +30.0 | N/A | +7.5 |
Table 4 Dosing recommendations for insulin and oral agents in management of diabetes during pregnancy
Drug class | Drug | Dosing |
Insulin | ||
Rapid-acting insulin | Insulin lispro | First trimester 0.7 units/kg/d. 14-18 wk 0.8 units/kg/d. 26-27 wk 0.9 units/kg/d. 36-37 wk until delivery 1 unit/kg/d[95] |
Insulin aspart | ||
Short-acting insulin | Regular insulin | First trimester 0.7 units/kg/d. 14-18 wk 0.8 units/kg/d. 26-27 wk 0.9 units/kg/d. 36-37 wk until delivery 1 unit/kg/d[95] |
Intermediate-acting insulin | NPH | Two thirds can be given prebreakfast and the remaining one third can be given during the pre-evening meal[95] |
Long-acting insulin | Detemir | 50% of total daily dose can be given in the pre-evening meal and the remaining 50% can be given as a basal insulin[95] |
Glargine | ||
Oral agents | ||
Biguanide | Metformin | 500 mg once or twice daily with an increase over 1 to 2 wk to a maximum daily dose of 2500 mg. 2000 mg if using metformin of extended release[90,92] |
Sulfonylurea | Glyburide | Starting dose of 2.5 to 5 mg once daily with an increase to a maximum dose of 20 mg/d[96] |
- Citation: Mendez Y, Alpuing Radilla LA, Delgadillo Chabolla LE, Castillo Cruz A, Luna J, Surani S. Gestational diabetes mellitus and COVID-19: The epidemic during the pandemic. World J Diabetes 2023; 14(8): 1178-1193
- URL: https://www.wjgnet.com/1948-9358/full/v14/i8/1178.htm
- DOI: https://dx.doi.org/10.4239/wjd.v14.i8.1178