Gestational Diabetes as a Maternal Risk Factor

Letters to the Editor In Vitro Fertilization Technology and Child Health Risks, Mechanisms, and Possible Consequences by Prof. Dr. med. Michael von Wolff, Prof. Dr. med. Thomas Haaf in issue 3/2020

Couples wishing to have children want a healthy child. However, most women with infertility have a risk history for gestational diabetes mellitus (GDM), such as insulin resistance and polycystic ovary syndrome (PCOS), if they have a precise medical history and pre-diagnosis. Indeed, following assisted reproductive technique (ART), 65% of women with insulin resistance, and 60% with PCOS, have GDM in early pregnancy (1), with an increased probability of gestational diseases and pregnancy loss. In their literature review, the authors list the health risks for children conceived with an assisted reproductive technique, which are similar to those for GDM: preterm birth, malformations, microsomies and macrosomies, and cardiovascular changes in later life. However, GDM is not mentioned as a possible and treatable maternal cause for the increased health risks in children conceived by ART (2).

If glucose tolerance disorders following ART were diagnosed as early GDM from the beginning of pregnancy, GDM therapy could be started immediately by diabetologists. The risk of severe morphological abnormalities, such as heart and brain malformations during embryogenesis, could then be reduced.

A healthy lifestyle before and during pregnancy is also an essential prerequisite for normal pregnancy and childbirth. A healthy diet has been shown to reduce the risk of infertility by up to 41% (3). Our own results with pre-conception metabolic intervention before a planned ART show a spontaneous conception rate of around 25% (4). These preventive measures can save ART cycles. Child health could be further strengthened by including ART in the GDM guideline: as soon as pregnancy is confirmed, testing must immediately determine whether an early GDM is present, which should then be treated.

DOI: 10.3238/arztebl.2020.0421b

Prof. Dr. med. Monika Bals-Pratsch M.Sc.

Dr. med. Angelika Eder M.Sc.

Dr. Dipl.-Biol. Dagmar Gutknecht

profertilita

Fachklinik für Fruchtbarkeitsmedizin

Regensburg, Germany

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Bals-Pratsch M, Großer B, Seifert B, Ortmann O, Seifarth C: Early onset and high prevalence of gestational diabetes in PCOS and insulin resistant women before and after assisted reproduction. Exp Clin Endocrinol Diabetes 2011; 119: 338–42

2. von Wolff M, Haaf T: In vitro fertilization technology and child health— risks, mechanisms and possible consequences. Dtsch Arztebl Int 2020; 117: 23–30

3. Grieger JA, Grzeskowiak LE, Bianco-Miotto T, et al.: Pre-pregnancy fast food and fruit intake is associated with time to pregnancy. Hum Reprod 2018; 33: 1063–70

4. Fill Malfertheiner S, Gutknecht D, Bals-Pratsch M: Preconception optimization of glucose and insulin metabolism in women wanting to conceive—high rate of spontaneous conception prior to planned assisted reproduction. Geburtshilfe Frauenheilkd 2017; 77: 1312–9