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Genetics of Gestational Diabetes Mellitus


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Presented by Dr. Mashfiqul Hasan (Phase B Resident, Endocrinology & Metabolism) on 27th May, 2013

Published in: Health & Medicine
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Genetics of Gestational Diabetes Mellitus

  1. 1. Genetics of GDMDr. Mashfiqul HasanPhase B ResidentDepartment of EndocrinologyBSMMU1
  2. 2. Overview of presentation• What is GDM• Pathogenesis of GDM• Importance of GDM• Genetics of GDM• Scope of Genetic study in BSMMU• Principles of genetic study2
  3. 3. 1. WHAT IS GDM?3
  4. 4. Definition• Any degree of glucose intolerance with onsetor first recognition during pregnancy• Whether or not the condition persisted afterpregnancy• Not excluding the possibility thatunrecognized glucose intolerance may haveantedated or begun concomitantly with thepregnancy4
  5. 5. Limitations ?5
  6. 6. To overcome the limitation• Screen women with risk factors for type 2diabetes for diabetes at their initial prenatalvisit, using standard diagnostic criteria• Women with diabetes found at this visitshould receive a diagnosis of overt, notgestational, diabetes6
  7. 7. Diagnostic criteria• Still much controversies• ADA 2013• When any of the following plasma glucosevalues are exceeded –– Fasting ≥ 5.1 mmol/L– 1h ≥ 10.0 mmol/L– 2h ≥ 8.5 mmol/L7
  9. 9. Hormone & fuel balance in pregnancy• Early pregnancy– Prepare the mother– Accentuation of fat deposition– Expansion of β cell mass– α cells remain unchanged9
  10. 10. Hormone & fuel balance in pregnancy• As the pregnancy progresses– Increasing insulin resistance (50%)– Increased insulin production from the previouslyexpanded cells (threefold)– Increased lipolysis in adipose tissue leads to a shifttoward fatty acid utilization by maternal tissues10
  11. 11. Hormone & fuel balance in pregnancy• Increased insulin resistance– Facilitated Anabolism• Increased lipolysis in mother– Accelerated starvation11
  12. 12. It is said that a large proportion of GDMwomen are experiencingFuture T2DM in advance13
  13. 13. 3. IMPORTANCE OF GDM14
  14. 14. Prevalence• Reflects prevalence of type 2 DM inpopulation• GDM affects 3% to 15% of pregnancies• In Bangladesh, a pilot study done in a tertiarycare hospital showed that the prevalence ofGDM was 7.8%• >30% in GDM study, BSMMU15
  15. 15. Complications of GDM• Fetal risk• Maternal risk• Future risk of DM16
  16. 16. 4. GENETICS OF GDM17
  17. 17. Heritability of GDM• Positive family history (45.1% in GDM study,BSMMU)• Both GDM women and their offspring are atincreased risk of future development of T2DM• It can be hypothesized that GDM and type 2diabetes share a common genetic background• It is not known whether there are genetic riskloci specific to GDM18
  18. 18. 19
  19. 19. Genetic factors in T2DM• Differences between ethnic groups• Concordance in Monozygotic twins• Clustering in family• Polygenic inheritence20
  20. 20. Approaches for genetic study1. Candidate gene study2. Genome wide association study21
  21. 21. 22
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  25. 25. Scope of GDM study, BSMMU• To investigate whether the candidate genesthat confer susceptibility to T2DM are alsocorrelated with GDM in pregnant Bangladeshiwomen.26
  27. 27. Building blocks of DNA28
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  33. 33. Acknowledgement34
  34. 34. Thank You35