Intermediate metabolism in normal pregnancy and in gestational diabetes

Abstract

Complex though integrated hormonal and metabolic changes characterize pregnancy. In the face of progressive decline in insulin action, glucose homeostasis is maintained through a compensatory increase in insulin secretion. This switches energy production from carbohydrates to lipids, making glucose readily available to the fetus. This precise and entangled hormonal and metabolic condition can, however, be disrupted and diabetic hyperglycemia can develop (gestational diabetes). The increase in plasma glucose level is believed to confer significant risk of complications to both the mother and the fetus and the newborn. Moreover, exposition of fetal tissues to the diabetic maternal environment can translate into an increased risk for development of diabetes and/or the metabolic syndrome in the adult life. In women with previous gestational diabetes, the risk of developing type 2 diabetes is greatly enhanced, to the point that GDM represents an early stage in the natural history of type 2 diabetes. In these women, accurate follow-up and prevention strategies are needed to reduce the subsequent development of overt diabetes. This paper will review current knowledge on the modifications occurring in normal pregnancy, while outlining the mechanisms. In this paper, we will review the changes of intermediary metabolism occurring during pregnancy. In particular, we will outline the mechanisms responsible for gestational diabetes; the link between these alterations and associated maternal and neonatal morbidity will be examined.

Assessment of Changes in Lipid Profile of Pregnant Women during Periods of Gestation and Post Partum in Chotanagpur – A Descriptive Study

“…However, for the triglyceride there was a steep rise from the control to the third trimester value with a non-mirror image decrease at the postpartum period. 17 Overall, the physiological mechanism in the postpartum period for return of the elevated lipid profile to pre-pregnant value is optimum. Some studies have also revealed that the mean values of serum TC, TG, and LDL are significantly higher among the hypertensive patients in comparison to normotensive.…”

The Management of Pregnancy in Maple Syrup Urine Disease: Experience with Two Patients

“…Firstly, the increased tolerance of natural protein during the later stages of the pregnancy was predicted as the requirements of the fetus grow considerably during this time and maternal physiology changes to accommodate this. Other endocrine changes during pregnancy promote insulin resistance and an anabolic state (Di Cianni et al 2003), also allowing increased protein tolerance. Careful monitoring was also required in the post-partum period.…”

Foetal Programming in a Diabetic Pregnancy: Long-Term Implications for the Offspring

“…Gestational steroid hormones and placental lactogen induce peripheral insulin resistance and enhance foetal nutrition by diverting glucose, fatty acids and amino acids from maternal to foetal tissues 6 . Diabetes results when the pancreatic -cells fail to cope with the increased demands for insulin.…”