Gestational diabetes and the metabolic syndrome: can obesity and small, dense low density lipoproteins be key mediators of this association?

Gestational diabetes mellitus (GDM) represents a condition of glucose intolerance with first appearance or recognition at the time of a pregnancy, associated with an inadequate pancreatic response to the advanced insulin resistance of the later stages of pregnancy, and accompanied by enhancing β-cell mass and secretion of insulin. Women who had GDM exhibit a higher risk for later advent of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). Additionally, previous GDM has been proposed as independently correlated with higher risk for development of atherosclerosis in a healthy population, similar to the metabolic syndrome (MetS) and independently of the presence of established CVD risk factors. Available data indicate multiple metabolic abnormalities common in women with GDM, including a high small dense low-density lipoprotein (sdLDL) concentration and a resultant high prevalence of CVD and the MetS. Preliminary data indicate that a measurement of sdLDL is worthwhile in women with GDM during pregnancy as well as the postpartum period. A close follow up of these women should be emphasized in clinical practice because GDM could predict not only eventual health risks for these mothers, but also their offspring. Thus, an improvement in care and risk modification of women with GDM may not only contribute towards improved CVD profile, but also potentially prevent adverse outcomes in their offspring. Lifestyle changes should be promoted in order to prevent excessive weight gain during pregnancy and decrease the risk of MetS in the postpartum and long-term.