Chapters authored
Biomarkers in GDM, Role in Early Detection and Prevention
Gestational Diabetes Mellitus (GDM) happens to be a very frequent and major complication of pregnancy because of higher morbidity and mortality, both for the mother and the baby. After delivery, GDM carries the risk of higher maternal morbidity due to post pregnancy obesity, development of diabetes mellitus, obesity and also cardiovascular diseases in significant number in both the mother and child for future. As per current guidelines, GDM is diagnosed at the end of the second trimester by elevated blood glucose values when, foetal damages by metabolic and epigenetic changes had already started. As a result, treatments cannot be started before the late second or third trimester, when the process of high risk of foetal morbidity and mortality has been set in. If by any method we can predict development of GDM at earliest part of first trimester or even more overjealously, we can predict, before pregnancy, then and then only we can avoid many disasters induced by GDM. With this idea many biomarkers, both clinical and laboratory based like clinical, metabolic, inflammatory and genetic markers etc., related with early pregnancy metabolic alterations have been studied for their potential to help in the prediction of later pregnancy glucose intolerance. Though promises are seen with some biomarker-enhanced risk prediction models for GDM, but lack of external validation and translation into day-to-day clinical applications, cost effectiveness, with which they may be utilized in routine prenatal care has limited their clinical use. But future is very promising and incorporating the biomarkers which precede the onset of hyperglycaemia into a risk prediction model for GDM and may help us for earlier risk assessment, screening, and diagnosis of GDM and also prevention of its both the immediate and remote complications. This review highlights the current knowledge of the understanding of the candidacy and practical utility of these biomarkers for GDM with recommendations for further research.
Part of the book: Gestational Diabetes Mellitus