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TYPE
Original Research
PAGE NO.
25-28
10.37547/tajmspr/Volume07Issue05-05
OPEN ACCESS
SUBMITED
15 March 2025
ACCEPTED
11 April 2025
PUBLISHED
13 May 2025
VOLUME
Vol.07 Issue05 2025
CITATION
Azimova S.B., Tadjibaeva R.B., & Abdunazarova M.I. (2025). The role of risk
factors in the development of diabetes mellitus in pregnant women. The
American Journal of Medical Sciences and Pharmaceutical Research, 7(05),
25
–
https://doi.org/10.37547/tajmspr/Volume07Issue05-05
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
The role of risk factors in
the development of
diabetes mellitus in
pregnant women
Azimova S.B.
Tashkent Medical Academy, Tashkent, Uzbekistan
Tadjibaeva R.B.
Tashkent Medical Academy, Tashkent, Uzbekistan
Abdunazarova M.I.
Tashkent Medical Academy, Tashkent, Uzbekistan
Abstract:
Gestational diabetes mellitus (GDM) is a
disease characterized by hyperglycemia, first detected
during pregnancy, but not corresponding to the
diagnostic criteria of manifest diabetes mellitus (DM).
According to modern concepts, pregnancy is a
"diabetogenic factor", since during gestation there is a
change in hemostasis of the female div, including
carbohydrate metabolism. Hyperglycemia during
pregnancy is associated with the development of
complications both on the part of the mother and the
fetus. In addition, GDM is a risk factor for the
development of obesity, type 2 diabetes and
cardiovascular diseases in the mother and offspring in
the future. According to the International Diabetes
Federation, approximately 14% of pregnancies are
associated with GDM, resulting in 18 million births per
year. All of these children are at risk of developing
obesity and type 2 diabetes. The increasing prevalence
of this disease, the high probability of adverse
pregnancy outcomes for the mother and fetus, and a
number of long-term consequences of GDM dictate the
need for its prevention by correcting risk factors, timely
diagnosis, and effective treatment of the disease.
Keywords:
Gestational diabetes mellitus, risk factor,
hyperglycemia, insulin resistance, pregnancy, obesity,
prediabetes.
Introduction:
Gestational diabetes mellitus (GDM) is
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The American Journal of Medical Sciences and Pharmaceutical Research
one of the most common diseases during pregnancy
and the most common type of diabetes mellitus (DM)
in pregnant women. Gestational diabetes mellitus
(GDM) is a common complication of pregnancy and can
lead to adverse maternal and fetal outcomes, such as
cesarean section, birth trauma, and the development
of type 2 diabetes mellitus (DM) in the future.
Gestational diabetes mellitus is characterized by
hyperglycemia that is first detected during pregnancy
but does not meet the diagnostic criteria for overt
diabetes mellitus (DM).
Most cases of gestational diabetes mellitus develop in
women with obesity, with a div mass index (BMI)
greater than 30. For example, in Finland in 2018, the
average BMI among pregnant women exceeded 25,
meaning they were overweight. More than 16% of
pregnant women were obese, with a BMI greater than
30. The American Diabetes Association estimates that
gestational diabetes occurs in 10% of pregnant women
in the United States [1]. According to the 2019
International Diabetes Federation Atlas, 15.8% (20.4
million) of women had hyperglycemia during
pregnancy, and 83.6% of these cases were diagnosed
with gestational diabetes mellitus [2]. The increase in
the number of pregnant women with this pathology is
directly related to the incidence of diabetes in the
world, improved quality of GDM diagnostics, an
increase in the proportion of women of reproductive
age who are overweight or obese, as well as late
planning of pregnancy and childbirth, and an increase
in the frequency of concomitant pathology [3].
The first prospective studies of glucose metabolism
during pregnancy were conducted in the 1950s and
1960s. In the late 1960s, the term gestational diabetes
mellitus was first coined [4], diagnostic criteria for
gestational diabetes were formulated, and screening
during pregnancy was introduced. Until recently, there
was no consensus in the world regarding the diagnostic
criteria for gestational diabetes. In European countries,
the diagnostic criteria of the WHO were most widely
used, according to which a glucose tolerance test (GTT)
was performed, similar to that performed outside of
pregnancy. The most recent large-scale multinational
study HAPO (Hyperglycemia and Adverse Pregnancy
Outcomes Study), which involved more than 25,000
pregnant women, showed a convincing relationship
between maternal hyperglycemia and adverse
pregnancy outcomes for both the mother and the fetus
and the child in the future. In 2008, in Pasadena (USA),
the International Association of Diabetes and
Pregnancy Study Groups (IADPSG) proposed new
diagnostic criteria for carbohydrate metabolism
disorders during pregnancy for discussion, based on
the results of the HAPO study. During 2010-2011, a
number of countries (USA, Japan, Germany, Israel, etc.)
adopted these criteria. In 2012, after repeated
discussions, the Russian Federation adopted the
Consensus on the Diagnosis and Treatment of GDM,
approved by the Ministry of Health of the Russian
Federation in 2013 [5]. Differences in epidemiological
indicators may be associated with the diversity of the
population groups studied. Thus, in countries with a low
risk of developing GDM in pregnant women, such as
Sweden, Australia, the USA (with the exception of
Native Americans and some other population groups),
the prevalence of this pathology is less than 2%, about
9.5% and 4.8%, respectively. Higher rates are observed
in the Middle East countries: the United Arab Emirates
(20.6%), Qatar (16.3%), Bahrain (13.5%) and Saudi
Arabia (12.5%). Some developed countries, such as
Canada (17.8%) and France (12.1%), also have higher
rates of prevalence of gestational carbohydrate
metabolism disorders. According to domestic authors,
the incidence of GDM in Russia varies widely - from 1 to
14%, averaging about 7%, and significantly depends on
diagnostic methods, ethnic composition of the
population, prevalence of type 2 diabetes in individual
populations, and economic conditions. It should be
noted that 91.6% of cases of hyperglycemia during
pregnancy are noted in low- and middle-income
countries, where maternal health care is often limited
[6]. In the modern world, gestational diabetes mellitus
(GDM) is a common disorder of carbohydrate
metabolism in pregnant women, which indicates the
undoubted relevance of this problem in women of
reproductive age. During pregnancy, genetically
determined changes occur in the woman's div, aimed
primarily at creating optimal conditions for the
functioning of the organs and systems of the pregnant
woman, ensuring the normal development of the fetus.
In the first trimester, a decrease in fasting glycemia is
noted (on average by 0.5-1.0 mmol / l), which is also due
to a decrease in the consumption of glucose and
gluconeogenesis substrates to meet energy needs
during the formation of the fetoplacental complex. An
increase in cortisol levels due to stimulation of the
adrenal
cortex
of
a
pregnant
woman
by
adrenocorticotropic hormone of the pituitary gland
under the influence of placental corticoliberin also
contributes to a decrease in tissue sensitivity to insulin.
The pathophysiology of gestational diabetes is based on
a functional decrease in insulin sensitivity (IS) or an
increase in insulin resistance (IR) in a pregnant woman
[7]. As a result, the β
-cells of the islet apparatus of the
pancreas perceive the level of glycemia abnormally,
which leads to insufficient insulin secretion for a given
level of glycemia. In the third trimester of pregnancy,
women with GDM experience an increase in insulin
concentration and a decrease in the suppression of
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The American Journal of Medical Sciences and Pharmaceutical Research
glucose production by the liver during insulin
administration. Hyperinsulinemia, developing in
response to hyperglycemia, increases peripheral IR
due to impaired autoregulation of insulin receptors,
which leads to a decrease in the sensitivity of
peripheral tissues to the effects of insulin and causes
compensatory hyperinsulinemia aimed at overcoming
the IR
barrier. Thus, a “vicious circle” of the “ascending
spiral” type develops, since each new high level of
compensatory hyperinsulinemia leads to worsening
insulin resistance.
GDM has risk factors similar to type 2 DM. Common
factors include age, heredity for DM, previous GDM,
birth of a fetus weighing more than 4000 g,
carbohydrate metabolism disorders, history of
glucosuria, obesity and overweight, female gender,
arterial hypertension, hyperlipidemia. Special risk
factors for GDM are complicated obstetric and
gynecological
history,
multiple
pregnancy,
polyhydramnios during this pregnancy, use of high
reproductive technologies, pathological weight gain
[8]. It is also necessary to note a number of non-
hormonal factors influencing the development of
hyperglycemia, such as decreased physical activity of
the pregnant woman, increased caloric intake, weight
gain due to the fat component, decreased
gastrointestinal motility [9]. The leading role in the
pathogenesis of pregnancy complications associated
with hyperglycemia belongs to microcirculatory
disorders. Oxidative stress induced in the ischemic
placenta is accompanied by activation of apoptosis,
endothelial dysfunction with possible development of
placental insufficiency, preeclampsia, fetal hypoxia
[10]. Considering the causes of GDM development in
women, it is important to note that this disease is
polyetiological.
Etiological
factors
of
GDM
development also include mutation of one or more
genes and genetic heterogeneity causing genetic
polymorphism. Specific monoclonal antibodies (AB)
are detected in 1.6
–
38% of pregnant women with GDM
–
GAD to β
-cells, insulin and HLA-DR3, HLA-DR4, which
are usually characteristic of individuals with a genetic
risk of developing type 1 diabetes mellitus. diabetes
mellitus (DM 1). Tumor necrosis factor-
α (TNF
-
α) also
plays a known role in the development of IR. Certain
risk factors influence the development of GDM,
including: overweight or obesity (BMI over 30 kg/m2),
significant weight gain after the age of 18, smoking,
multiple pregnancies, family history of type 2 diabetes,
impaired glucose tolerance before pregnancy,
polyhydramnios or a history of a large fetus, the birth
of a child weighing more than 4000 g or stillbirth - a
history of pregnancy, the development of defects in
children, rapid weight gain during this pregnancy, the
woman's age over 30 years.[11]
CONCLUSION
GDM is an important medical and social problem that
significantly increases the risk of obstetric and
metabolic complications in women and their offspring.
Conducting
additional
studies
assessing
the
epidemiological characteristics of GDM, the structure of
risk factors, as well as an in-depth study of the
pathogenetic mechanisms of its development is
advisable to expand our understanding of the real scale
of the problem and improve the possibilities of
managing this disease.
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