A short presentation on gestational diabetes mellitus

2. Genetic and epigenetic alterations of candidate genes in
Gestational Diabetes Mellitus (GDM)
Presented By
Amreen Shamsad
(2018-19)
Department of Zoology
University of Lucknow
Lucknow
In partial fulfillment of the award of degree
DOCTOR OF PHILOSOPHY
(Supervisor) (Co-Supervisor)
Prof. Monisha banerjee Prof. RenuSingh
Molecular & Human Genetics Lab. Department of Obst. & Gynecology
Department of Zoology KGMU Lucknow
University of Lucknow , Lucknow

3. Gestational Diabetes Mellitus (GDM)
 Hyperglycemic condition recognized for the first time during pregnancy.
 Most prevalent metabolic disorder during pregnancy –ADA, Diabetes Care 2018.
 Precursor of Diabetes.
Prevalence of GDM
 Vary according to Ethnic Differences, Screening procedure, Diagnostic methods employed,
Maternal age etc.
 In developed Countries: 1- 20%
 In developing Countries: 0.6-18.9%

4. Risk Factors For GDM
S.N
.
Risk Factors
1. Previous history of GDM or impaired glucose tolerance
2. Obesity
3. Ethnicity (African, Hispanic, South or East Asian, Native
American)
4. Family history of GDM or Type 2 diabetes
5. Advanced maternal age/ High parity
6. Excess weight gain in pregnancy
7. Previous history of macrosomic baby
8. Pregnancy –induced or pre-existing Hypertension
9. Insulin resistant conditions (Metabolic syndrome, polycystic ovary
syndrome)
10. Smoking during pregnancy

5. Complications
Fetal Complications
Macrosomia, Neonatal
hypoglycemia, Prenatal
mortality, Congenital
malformation,
Hyperbilirubinemia,
Polycythemia, Hypocalcaemia,
Hyperinsulinemia ,
development of Type 2 diabetes
in future
Maternal Complications
Hypertension, Preeclampsia, Increased
risk of cesarean delivery, development
of Type 2 diabetes in future

6. Diagnosis of GDM
ADA (American Diabetes
Association )
WHO (World Health
Organization)
DIPSI (Diabetes in Pregnancy
Study Group India)
Strategy
50g glucose challenge test
1 hr plasma glucose value >140
mg/dl
Then 100g (glucose) OGTT should
be performed, values exceed 2 of the
following:
fasting >95 mg/dl
1-hour >180 mg/dl
2-hour >155 mg/dl
3-hour >140 mg/dl
Strategy
During a 75 g
glucose challenge,
exceeds 1 of the following:
fasting > 126 mg/dl
2-hour glucose >140 mg/dl
Strategy
During a 75 g
glucose challenge, without regard of
fasting or non fasting state :
2-hour glucose >140 mg/dl

7. Genetics of GDM
Genes Human Genome
Organization (HUGO)
abbreviation
dbSNP marker
Transcription factor 7-like 2 TCF7L2 rs7903146
Insulin-like growth factor 2
mRNA-binding protein 2
IGF2BP2 rs4402960
Potassium channel, voltage-
gated, KQT-like subfamily,
member 1
KCNQ1 rs2237895, rs2237892,
rs2237897, rs2283228
Fat mass- and obesity-
associated gene
FTO rs9939609
Cyclin-dependent kinase
inhibitor 2A and 2B
CDKN2A/B rs10811661
Haematopoietically expressed
homeobox/insulin-degrading
enzyme/kinesin
family member 11
HHEX/IDE/KIF11 rs1111875, rs7923837

8. Management of GDM
Dietary Modification Exercise
Pharmacological
Treatment
Treatment of GDM

9. Conclusion
 GDM is a growing health concern, especially in certain predisposed populations.
 GDM may have serious long-term consequences for both child and mother.
 It is likely that genetic, epigenetic, and environmental factors all contribute to the
development of GDM, and that the mechanisms involved are complex and advance
over a substantial period of time.
 Early diagnosis of GDM is necessary to reduce maternal and fetal morbidity and
help to prevent or delay the onset of T2D.
 Knowledge about the genetics of GDM will help to prevent complications.

10. References
 American Diabetes Association (2018). Classification and Diagnosis of Diabetes:
Standards of Medical Care in Diabetes. Diabetes Care 41: S13-S27.
 Bao W, Bowers K, Tobias DK, et al (2014). Pre-pregnancy low-carbohydrate dietary
pattern and risk of gestational diabetes mellitus: A prospective cohort study.
American Journal of Clinical Nutrition 99: 1378-1384.
 Chiefari E, Arcidiacono B, Foti D, et al (2017). Gestational diabetes mellitus: An
updated overview Journal of Endocrinological Investigation 40: 899-909.
 Siddiqui S, Waghdhare S, Panda M, et al (2019). Regional prevalence of gestational
diabetes mellitus in North India. Journal of diabetology 10: 25-28.
 Swami SR, Mehetre R, Shivane V, et al (2008). Prevalence of carbohydrate
intolerance of varying degrees in pregnant females in western India (Maharashtra)--a
hospital-based study. Journal of the Indian Medical Association 106: 712-714.

11. THANKYOU