Among pregnant women diagnosed with gestational diabetes mellitus, which of the following is the most common maternal complication during pregnancy and labour?
A. Preeclampsia
B. Polyhydramnios
C. Maternal hypoglycemia requiring ICU admission
D. Intrauterine fetal death
Explanation
Maternal Complications of Gestational Diabetes
Key Point
Preeclampsia is the most common maternal complication of GDM, occurring in 15–25% of women with GDM compared to 5–10% in non-diabetic pregnancies.
Why Preeclampsia Is Most Common in GDM
High-YieldNEET PG
The link between GDM and preeclampsia is multifactorial:
1.
Endothelial dysfunction — Hyperglycemia and hyperinsulinemia impair endothelial nitric oxide production
2.
Oxidative stress — Increased reactive oxygen species in GDM
3.
Inflammatory state — Elevated inflammatory cytokines (TNF-α, IL-6)
4.
Shared risk factors — Obesity, insulin resistance, and metabolic syndrome predispose to both GDM and preeclampsia
5.
Placental insufficiency — Abnormal placentation in GDM increases preeclampsia risk
Frequency of Maternal Complications in GDM
Table
Complication
Incidence in GDM
Incidence in Non-GDM
Comment
Preeclampsia
15–25%
5–10%
Most common maternal complication
Polyhydramnios
5–10%
1–2%
Associated with fetal hyperglycemia and osmotic diuresis
Intrauterine fetal death
1–2%
0.3–0.5%
Rare with modern management; more common in undiagnosed/uncontrolled GDM
Maternal hypoglycemia
<1%
N/A
Only if insulin overdosed; not a natural GDM complication
Cesarean delivery
30–50%
15–20%
Due to macrosomia, cephalopelvic disproportion
Clinical Pearl
Women with GDM have a 3-fold increased risk of preeclampsia compared to non-diabetic pregnancies. This is one of the strongest independent associations and should prompt close monitoring of blood pressure and proteinuria from diagnosis onwards.
Mnemonic for GDM maternal complications: PREP
Preeclampsia (most common)
Renal complications (diabetic nephropathy if pre-existing diabetes)
Eye complications (diabetic retinopathy if pre-existing diabetes)
