Gestational Diabetes
Diabetes developing during pregnancy in women without pre-existing diabetes. It is caused by pregnancy-related hormonal changes that increase insulin resistance. GLP-1 receptor agonists are generally not approved for gestational diabetes, and most are contraindicated in pregnancy.
Technical Context
GDM affects approximately 2-10% of pregnancies and increases risks of macrosomia, neonatal hypoglycaemia, pre-eclampsia, and future T2D (50% of women with GDM develop T2D within 5-10 years). Diagnosis: oral glucose tolerance test (75g OGTT) at 24-28 weeks gestation using IADPSG criteria. Management: dietary modification, exercise, and insulin if glycaemic targets are not met (insulin does not cross the placenta). GLP-1 RAs and most peptide drugs are NOT approved for use in pregnancy. Animal reproductive toxicity data for GLP-1 RAs have shown embryo-foetal effects at high doses. Women of childbearing potential are advised to discontinue GLP-1 RAs at least 2 months before planned pregnancy due to the prolonged half-life of some agents.