Gestational diabetes mellitusmore than the eye can see ana warning sign for future maternal health with transgenerational impact

Manal Massalha ^1,2 Rula Iskander ¹ haya Hassan ¹ Etty Spiegel ¹ Offer Erez ^3,4* Zohar Nachum ^1,2

• ¹ Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel., Afula, Israel
• ² Rappaport Faculty of Medicine, Technion, Institute of technology, Afula, Israel
• ³ Obstetrics and Gynecology, Soroka Medical Center, Beersheba, Israel
• ⁴ Ben-Gurion University of the Negev, Be'er Sheva, Southern District, Israel

Gestational diabetes mellitus (GDM) is regarded by many as maternal maladaptation to physiological insulin resistance during the second half of pregnancy. However, recent evidence indicates that alterations in carbohydrate metabolism can already be detected in early pregnancy. This observation, the increasing prevalence of GDM, and the significant short and long-term implications for the mother and offspring call for reevaluation of the conceptual paradigm of GDM as a syndrome. This review will present evidence for the syndromic nature of GDM and the controversies regarding screening, diagnosis, management, and treatment.Maternal insulin resistance, which develops physiologically during the second half of pregnancy, serves the increasing fetal requirements for free glucose required to support growth. Disruption in the maternal metabolic support of pregnancy can lead to pregnancy complications such as fetal growth restriction, and preterm birth [1] in case of in sufficient support and diabetes mellitus on cases of increased glucose supply. However, GDM is an obstetric syndrome characterized by multiple etiologies, a long subclinical phase, fetal involvement, and complex gene-environment interactions [2].