Endocrinol Metab.  2025 Feb;40(1):10-25. 10.3803/EnM.2024.2264.

Gestational Diabetes Mellitus: Mechanisms Underlying Maternal and Fetal Complications

• Lee J
• Lee NK
• Moon JH

• KMID: 2565247
• DOI: http://doi.org/10.3803/EnM.2024.2264

Abstract

Gestational diabetes mellitus (GDM) affects over 10% of all pregnancies, both in Korea and worldwide. GDM not only increases the risk of adverse pregnancy outcomes such as preeclampsia, preterm birth, macrosomia, neonatal hypoglycemia, and shoulder dystocia, but it also significantly increases the risk of developing postpartum type 2 diabetes mellitus and cardiovascular disease in the mother. Additionally, GDM is linked to a higher risk of childhood obesity and diabetes in offspring, as well as neurodevelopmental disorders, including autistic spectrum disorder. This review offers a comprehensive summary of clinical epidemiological studies concerning maternal and fetal complications and explores mechanistic investigations that reveal the underlying pathophysiology.

Keyword

Diabetes, gestational; Diabetes complications; Pregnancy complications, cardiovascular; Fetal development; Neurodevelopmental disorders

Figure

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  Fig. 1. Maternal metabolic health and fetal pathophysiology: impact of adipokines and cytokines on fetal development. Maternal metabolic health plays a critical role in regulating the secretion of adipokines, such as adiponectin and leptin, as well as pro-inflammatory cytokines, including interleukin 1β and tumor necrosis factor α. These molecules can cross the placenta, impacting fetal physiology, chromatin structure, and immune priming, thereby potentially contributing to adverse fetal outcomes.

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