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Gestational diabetes mellitus: onset, causes and management

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Nurses in primary care can advise women at risk of GDM and inform them of management and pregnancy follow-up care

Gestational diabetes mellitus (GDM) can be defined as glucose intolerance with onset or first recognition occurring during pregnancy.1

GDM is a more common cause of diabetes in pregnancy than pre-existing diabetes, accounting for nearly 90% of cases, and its prevalence is increasing in line with rising body mass index.2 GDM can lead to significant problems for both foetus and mother during pregnancy and delivery, as well as for the neonate. Additionally, there are important long-term adverse consequences for both the child and mother.

Therefore, it is important that primary care practitioners can appropriately advise women at high risk of GDM, understand the management of GDM, and assume responsibility for post‑pregnancy follow-up of GDM.3

Underlying causes

Insulin resistance rises as pregnancy progresses and under normal circumstances this is countered by increasing insulin production from pancreatic beta cells. Women with GDM inherently have a greater degree of insulin resistance compared to women without GDM and this, coupled with reduced beta-cell capacity to produce the required insulin response, leads to maternal hyperglycaemia.4

Who is at risk?

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