Which of the following are maternal complications of GDM? Select all that apply

Preeclampsia is a multisystem disorder of pregnancy characterized by hypertension, proteinuria, endothelial dysfunction, and organ ischemia. It typically occurs after 20 weeks gestation and may progress rapidly. Severe features include systolic blood pressure ≥160 mmHg, diastolic ≥110 mmHg, elevated liver enzymes, thrombocytopenia <100,000/mm³, and persistent epigastric or right upper quadrant pain due to hepatic involvement.

Rationale for correct answer

2. Epigastric pain in a patient with gestational diabetes mellitus (GDM) raises concern for hepatic capsular distension due to periportal necrosis, a hallmark of severe preeclampsia. This symptom reflects liver involvement and may precede HELLP syndrome. Immediate reporting is essential to prevent progression to eclampsia or placental abruption.

Rationale for incorrect answers

1. Increased appetite is not a feature of preeclampsia. It may occur in GDM due to fluctuating glucose levels or insulin adjustments but does not indicate organ dysfunction. It lacks correlation with vascular compromise or hepatic involvement.

3. Mild fatigue is nonspecific and common in pregnancy due to increased metabolic demand and hormonal shifts. It does not reflect end-organ damage or signal an acute complication. It lacks diagnostic specificity for preeclampsia.

4. Frequent urination is typical in pregnancy due to uterine pressure on the bladder and increased glomerular filtration rate. It is not associated with preeclampsia unless accompanied by oliguria or proteinuria. It does not indicate systemic compromise.

Take home points

• Epigastric pain in pregnancy may signal hepatic involvement in preeclampsia.
• GDM increases risk for preeclampsia due to vascular and metabolic stress.
• Fatigue and urinary frequency are common but nonspecific pregnancy symptoms.
• HELLP syndrome may present with epigastric pain before lab abnormalities.

Polyhydramnios is defined as excessive amniotic fluid volume, typically an amniotic fluid index (AFI) >24 cm or single deepest pocket >8 cm. It is associated with fetal anomalies, maternal diabetes, uterine overdistension, and preterm labor. The excess fluid stretches the uterus, triggering contractions and cervical changes. It may also cause malpresentation and cord prolapse. Common causes include fetal anencephaly, esophageal atresia, and uncontrolled hyperglycemia.

Rationale for correct answer

2. Preterm labor is a direct consequence of uterine overdistension caused by excessive amniotic fluid. The stretched myometrium increases contractility, leading to cervical effacement and dilation before 37 weeks. In gestational diabetes mellitus, poor glycemic control contributes to fetal polyuria and fluid accumulation, increasing this risk.

Rationale for incorrect answers

1. Oligohydramnios is the opposite of polyhydramnios and involves reduced amniotic fluid volume (AFI <5 cm). It is associated with placental insufficiency and renal anomalies, not maternal diabetes. It does not result from excess fluid and is not a complication of polyhydramnios.

3. Placenta previa involves abnormal placental implantation over the cervical os. It is linked to prior cesarean delivery and multiparity, not fluid volume abnormalities. Polyhydramnios does not affect placental location or increase risk for previa.

4. Vasa previa is a rare condition where fetal vessels traverse the membranes over the cervical os. It is associated with velamentous cord insertion and accessory lobes, not polyhydramnios. Excess fluid does not predispose to abnormal vessel placement.

Take home points

• Polyhydramnios increases uterine stretch and risk for preterm labor.
• Gestational diabetes causes fetal polyuria, contributing to fluid excess.
• Oligohydramnios is associated with placental insufficiency and renal defects.
• Vasa previa and placenta previa are structural, not fluid-related complications.