Gestational Diabetes and the Metabolic Syndrome: Can Obesity and Small, Dense Low Density Lipoproteins Be Key Mediators Of This Association?

Abstract

Gestational diabetes mellitus (GDM) is a state of glucose intolerance with first appearance or recognition during pregnancy, associated with an inadequate pancreatic response to the progressive insulin resistance of the later stages of gestation, and accompanied by increasing beta-cell mass and insulin secretion. Women with a history of GDM exhibit a greater risk for developing type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Additionally, previous GDM has been proposed as independently associated with increased atherosclerosis risk in a healthy population, similar to the metabolic syndrome (MetS) and independently of the presence of established CVD risk factors. Available data indicate multiple metabolic abnormalities common in women with GDM, including a high small dense low-density lipoprotein (sdLDL) concentration and a resultant high prevalence of CVD and MetS. Preliminary data indicate that measurement of sdLDL is worthwhile in women with GDM during pregnancy as well as the postpartum period. A close follow up of these women should be emphasized in clinical practice because GDM is a predictor not only of future health risks for these mothers, but also their offspring. Thus, an improvement in care and risk modification of women with GDM may not only contribute towards improved CVD profile, but also potentially prevent adverse outcomes in their offspring. Lifestyle changes should be promoted in order to prevent excessive weight gain during pregnancy and decrease the risk of MetS in the postpartum and long-term.