GDM as a unique pathophysiological entity or a transitional pregnancy-induced glucose metabolism abnormality identifying primary diabetes types?

Gestational diabetes mellitus is defined as glucose intolerance first diagnosed during pregnancy; however, this diagnosis may actually represent a heterogeneous spectrum of primary diabetes phenotypes unmasked by the metabolic stress of pregnancy rather than a single pathophysiological entity. The current review aims to summarise available knowledge about the diabetes spectrum in pregnancy with particular focus on its pathophysiology, risk factors and postpartum destiny. Another aim was to discuss possibilities for stratification of the women according to their immediate and future risks of postpartum persistence of glucose intolerance and its complications in later life. Specific objectives of the paper are: (1) to summarise data on physiological metabolic changes in pregnancy, (2) characterise the diabetes spectrum in pregnancy, (3) address the current state of the art in GDM diagnosis and management, (4) to summarize data on postnatal development and maturation of the infants who experienced GDM in utero and, finally (5) discuss possibilities to stratify GDM women according to the later risk for persistence of glucose intolerance after delivery.