The Lancet series on gestational diabetes mellitus (GDM) sheds light on the complexities of the condition, and advocates for change in future care and management.

“GDM is the most common medical disorder in pregnancy, and it is on the rise globally. We hope the Lancet series can reach a wide array of clinicians, doctors, and researchers and create awareness of the complexities surrounding GDM and GDM detection, care, and follow-up,” says Karoline Kragelund Nielsen, Research Group Leader and Senior Researcher at Steno Diabetes Center Copenhagen

This summer saw the publication of The Lancet series on gestational diabetes.

The Lancet series presents insights into the pathophysiology and management of Gestational Diabetes Mellitus (GDM), suggesting, among other things, that the current approach to treatment should shift into a personalised, holistic life-course approach.

We spoke with two authors from the series, DDEA Visiting Professor Patrick Catalano and former DDA grant recipient Karoline Kragelund Nielsen.

About Gestational Diabetes Mellitus

According to the Lancet, Gestational Diabetes Mellitus (GDM) is the most common medical pregnancy complication worldwide. Early diagnosis and treatment of GDM is greatly needed to improve the health of both woman and child.

Explore key findings and recommendations from the series in their infographic.

Changing the Understanding of GDM

Patrick Catalano is a Professor in Residence in the Division of Reproductive Endocrinology at the Department of Medicine at Massachusetts General Hospital, Harvard Medical School, USA, as well as a DDEA Visiting Researcher at Aarhus University in Denmark.

Professor Catalano co-authored two papers in the Lancet series, ‘Pathophysiology from preconception, during pregnancy, and beyond’ and ‘Epidemiology and management of gestational diabetes’.

“I have conducted several longitudinal studies examining the pathophysiology of GDM, using techniques such as the hyperinsulinemic clamp, stable isotopes, body composition, etc. My goal was to try and demonstrate that the metabolic abnormalities in pregnancy are present before conception. The clinical manifestation of high glucose, used to diagnose GDM, occurs because of placental factors in pregnancy which alter insulin sensitivity and pancreatic beta cell function. This demonstrates that GDM is a metabolic disorder that exists prior to conception,” explains Professor Patrick Catalano.

“Diagnosing and treating GDM earlier in pregnancy may improve perinatal outcomes and long-term outcomes for the offspring,” he adds.

Another element of Professor Catalano’s research and contribution to the Lancet series is how metabolic adaptations to pregnancy affect other nutrients besides glucose, such as lipids. His and other researchers’ work presented in the series proves that there is still plenty more to investigate concerning GDM.

“Additional research needs to be conducted not only in early pregnancy, but before and after pregnancy, as these are life-course problems of metabolism that exist before pregnancy and persist postpartum,” says Professor Patrick Catalano.

Addressing Key Barriers

Karoline Kragelund Nielsen is a research group leader and senior researcher at Steno Diabetes Center Copenhagen. She is part of the Face-it project which aims to reduce the risk of diabetes and increase the quality of life of families where the mother has a history of GDM with a tailored postpartum intervention programme.

Karoline is co-author of the third paper in the Lancet series titled ‘Call to action for a life course approach’.

The series identifies different barriers to providing appropriate care and long-term prevention of type 2 diabetes for women with GDM. Two key barriers are resources and the fragmentation of GDM care from primary care.

“Women with prior GDM are at high risk of developing type 2 diabetes. Yet, we see that many of them are not getting tested or supported with health-promoting efforts to reduce this risk. These women are already ‘in the system’ and have several different interactions with doctors, nurses, etc. in the first years after giving birth, but the systems are isolated, they often don’t communicate with each other. So, we’re missing the opportunity for proper integration and follow-up,” says Karoline Kragelund Nielsen.

Redefining GDM Care

The ‘Call to action for a life course approach’ paper in the Lancet series presents ideas on optimising the current models of GDM care, with emphasis on expanding the focus to a life-course approach.

“One of the things we suggest is to integrate GDM management into routine maternal and child health services, and to move towards a more holistic and personalised life-course approach. GDM is a heterogeneous condition that differs greatly from person to person, and the approach to its care, treatment, and follow-up ought to reflect that. This applies not just to high-income countries, but also, and maybe especially, to middle-income countries with a higher overall risk of GDM,” says Karoline Kragelund Nielsen.

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