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World J Diabetes. Jun 15, 2019; 10(6): 333-340
Published online Jun 15, 2019. doi: 10.4239/wjd.v10.i6.333
Exploration of the shared pathophysiological mechanisms of gestational diabetes and large for gestational age offspring
Sofia Nahavandi, Sarah Price, Priya Sumithran, Elif Ilhan Ekinci
Sofia Nahavandi, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
Sarah Price, Priya Sumithran, Elif Ilhan Ekinci, Department of Endocrinology, Austin Health, Repatriation Campus Heidelberg West, Melbourne, VIC 3081, Australia
Sarah Price, Priya Sumithran, Elif Ilhan Ekinci, Department of Medicine, Austin Health and the University of Melbourne (Austin Campus), Parkville, Melbourne, VIC 3084, Australia
Author contributions: Nahavandi S was the primary author. Price S, Sumithran P, and Ekinci EI provided subject matter expertise and edited the manuscript.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Elif Ilhan Ekinci, FRACP, MBBS, PhD, Associate Professor, Sir Edward Dunlop Medical Research Foundation Principal Research Fellow in Metabolic Medicine, Department of Medicine, Austin Health and the University of Melbourne (Austin Campus), Level 1, Centaur Wing, Heidelberg Repatriation Hospital, 300 Waterdale Road, Melbourne, VIC 3084, Australia. elif.ekinci@unimelb.edu.au
Telephone: +61-03-94962250 Fax: +61-03-94974554
Received: March 30, 2019
Peer-review started: April 3, 2019
First decision: May 8, 2019
Revised: May 13, 2019
Accepted: May 23, 2019
Article in press: May 23, 2019
Published online: June 15, 2019
Abstract

Gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for the conditions and an increased prevalence of LGA offspring amongst pregnancies affected by GDM. Thus, it is important to elucidate potential shared underlying mechanisms of both LGA and GDM. One potential mechanistic link relates to macronutrient metabolism. Indeed, derangement of carbohydrate and lipid metabolism is present in GDM, and maternal biomarkers of glucose and lipid control are associated with LGA neonates in such pregnancies. The aim of this paper is therefore to reflect on the existing nutritional guidelines for GDM in light of our understanding of the pathophysiological mechanisms of GDM and LGA offspring. Lifestyle modification is first line treatment for GDM, and while there is some promise that nutritional interventions may favourably impact outcomes, there is a lack of definitive evidence that changing the macronutrient composition of the diet reduces the incidence of either GDM or LGA offspring. The quality of the available evidence is a major issue, and rigorous trials are needed to inform evidence-based treatment guidelines.

Keywords: Gestational diabetes mellitus, Large for gestational age, Metabolism, Biomarkers, Glucose, Lipids

Core tip: The prevalence of gestational diabetes is on the rise, warranting attention on the consequences for mother and offspring, as well as management options. One consequence is an increased risk of large for gestational age (LGA) offspring. While deranged macronutrient metabolism of carbohydrate and lipids in gestational diabetes may play a role in fetal overgrowth, there is a lack of conclusive evidence that dietary interventions employed as first-line gestational diabetes management reduces this risk of LGA offspring.