GESTATIONAL DIABETES MELLITUS: IMPLICATIONS FOR MATERNAL-FETAL HEALTH, INTERGENERATIONAL RISKS AND PREVENTIVE APPROACHES

Abstract

Diabetes mellitus is a condition with a global impact, responsible for millions of deaths annually and affecting a significant portion of the world's adult population. Among its manifestations, gestational diabetes mellitus (GDM) stands out as a growing public health concern due to its high prevalence, maternal-fetal complications, and potential intergenerational risks. This condition, characterized by hyperglycemia induced by insulin resistance during pregnancy, presents global variations in incidence, influenced by diagnostic factors and population characteristics. In addition to compromising maternal-fetal health, GDM is associated with high rates of perinatal morbidity and mortality, reinforcing the need for preventive strategies, such as early screening and encouraging healthy habits during prenatal care. In the context of global challenges, such as the increase in obesity and the search for reducing maternal and infant mortality, GDM emerges as a priority problem. Early detection and effective management of this condition are essential to mitigate its complications and promote better short- and long-term outcomes for mothers and children. This study aims to analyze gestational diabetes mellitus, with an emphasis on its implications for maternal-fetal health, intergenerational risks, and preventive approaches. This is a broad integrative literature review, carried out in 2024, based on consultations on the MEDLINE, PubMed, and SciELO platforms. Furthermore, in the last two decades, there has been a significant increase in the incidence of GDM, driven by factors such as maternal aging, sedentary lifestyle, and obesity. GDM is associated with maternal metabolic alterations, including insulin resistance, which, although necessary to meet fetal demands, can lead to significant complications. Approximately 40% of women with GDM develop type 2 diabetes within 10 years after delivery, especially obese women. Risk factors include advanced age, family history of type 2 diabetes, obesity, and sedentary lifestyle. The coexistence of GDM and obesity increases risks such as preeclampsia, premature birth, and neonatal complications, as well as mental health repercussions such as postpartum depression. On the other hand, preventive interventions such as weight control, a balanced diet, and physical exercise have been shown to reduce the incidence of GDM and its complications. From a neonatal perspective, children of mothers with GDM have a higher risk of macrosomia, hypoglycemia, and long-term metabolic complications such as obesity and diabetes in adulthood. GDM is also associated with epigenetic alterations, reinforcing the impact of the intrauterine environment on future health. Early diagnosis is essential, with strategies based on glycemic tests and international criteria, while pharmacological therapies such as insulin and metformin play a fundamental role in management. In addition, emerging technologies such as continuous monitoring devices and artificial intelligence have revolutionized care, promoting greater effectiveness and personalization. Finally, we highlight the importance of multidisciplinary approaches in the management of GDM, combining clinical interventions, health education, and public policies to mitigate the impacts of the condition and ensure better maternal-fetal outcomes. We conclude that GDM has significant impacts on maternal-fetal and intergenerational health, contributing to complications during pregnancy and increasing the predisposition to chronic diseases in affected women and their offspring. Factors such as macrosomia, neonatal hypoglycemia, and metabolic disorders highlight the need for effective interventions. Preventive strategies, such as early screening, a balanced diet, physical exercise, and pharmacological therapies, play an important role in reducing the risks associated with GDM. Awareness of preconception care and multidisciplinary management are essential to improve maternal and child health, reduce economic costs, and mitigate the burden on health systems.