Pelvic floor dysfunction in patients with gestational diabetes mellitus

In this editorial, we comment on an article by Wang et al. Recent literature shows an increase in research on pelvic organ prolapse (POP). Although the true incidence of POP remains uncertain, its impact on quality of life is substantial. Anatomical studies report high incidence rates, surpassing those observed in symptom-based surveys. Weakness of the endopelvic fascia is a primary anatomical risk factor for POP. Additionally, gestational diabetes mellitus (GDM) has emerged as a growing concern, as poor glycemic control increases complications for both mother and fetus. GDM and POP are interconnected, with factors like maternal obesity, macrosomia, and hormonal changes exacerbating pelvic floor dysfunction. Modifiable risk factors, such as obesity and chronic hyperglycemia, along with multiparity, instrumental deliveries, and obstetric trauma, further increase susceptibility. For patients with GDM, gynecological exams, Pelvic Organ Prolapse Quantification staging, and pelvic floor ultrasonography are valuable diagnostics, with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses. Imaging, though uncomfortable during pregnancy, is safe in the early postpartum period. This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.