Gestational Diabetes Mellitus - A Perspective

نویسندگان

  • Veerasamy Seshiah
  • Vijayam Balaji
  • Balaji Madhuri
چکیده

The prevalence of diabetes is increasing globally and the total number of people with this condition is projected to rise from 171 million in 2000 to 366 million in 2030 (Wild et al, 2004). India is no exception, with projected rates of 79.4 million in 2030—a 151% increase from 31.7 million in 2000 (Wild et al, 2004). The increased prevalence is attributed to the aging population structure, urbanization, the obesity epidemic, and physical inactivity (Hunt & Schuller, 2007). While all these factors contribute to the epidemic of diabetes, intrauterine exposures are emerging as potential risk factors (Barker, 1995). The “fetal origin of adult disease” hypothesis proposes that gestational programming may critically influence adult health and disease (Barker, 1995). Gestational programming is a process whereby stimuli or stresses occurring at critical or sensitive periods of fetal development, permanently change structure, physiology, and metabolism, which predisposes individuals to disease in adult life (Lucas, 1991). If the stimulus happens to be glucose intolerance in pregnancy, it predisposes the offspring to an increased risk of developing glucose intolerance in the future. This vicious cycle is likely to influence and perpetuate the incidence and prevalence of glucose intolerance in any population (Seshiah et al., 2004). Therefore, preventive measures against type 2 diabetes should start during the intrauterine period and continue from early childhood throughout life (Tuomilehto, 2005). In this respect, detection of gestational diabetes mellitus (GDM), defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy (Metzger, 1991), becomes an important public health issue. The etiopathogenesis of glucose intolerance that develops in women with GDM could be the result of their inability to increase insulin secretion enough to overcome insulin resistance that occurs even in non diabetic pregnancy (Kuhl et al., 1985). The present concept is that GDM represents, detection of chronic β cell dysfunction, rather than development of relative insulin deficiency as insulin resistance increases during pregnancy (Buchanan et al., 2007).

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تاریخ انتشار 2012