Intermediary Metabolism During Normal Pregnancy

Freinkel, Norbert; Phelps, Richard; Metzger, Boyd E.

doi:10.1007/978-3-642-66972-9_1

Cited by 16 publications

(5 citation statements)

References 66 publications

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“…7 The present report compares results in eight pregnant women with normal oral glucose tolerance (NM), in seven with GDM < 105, and in six with GDM ^ 105. Since pregnancy per se alters the mobilization of endogenous and the disposition of exogenous fuels, 2 it was felt that studies in gravid subjects with NM were mandatory as a baseline against which to compare the findings in GDM.…”

Section: Methodsmentioning

confidence: 99%

Effects of Gestational Diabetes on Diurnal Profiles of Plasma Glucose, Lipids, and Individual Amino Acids

et al. 1980

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To assess the effects of gestational diabetes mellitus (GDM) on intermediary metabolism in late pregnancy, circulating levels of glucose, FFA, triglycerides, cholesterol, and individual amino acids were monitored for 24 h while subjects received a liquid formula diet (containing 2110 cal and 275 g carbohydrate) in three equal feedings at 0800, 1300, and 1800. Attempts were made to distinguish between varying degrees of severity of gestational diabetes by subdividing the population into those with fasting plasma glucose within the normal range for pregnancy, i.e., below 105 mg/dl (GDM < 105), and those with fasting plasma glucose of 105 mg/dl or greater (GDM ^ 105). Both groups were compared with pregnant women with normal carbohydrate metabolism (NM). The diurnal profiles indicated that premeal, postprandial averages, and integrated 24-h values for plasma glucose were consistently higher in GDM ^ 105 than in GDM < 105; both GDM groups uniformly exceeded the values in NM. Plasma FFA tended to be higher in all GDM, with maximal increments occurring in the early hours before breakfast and assuming greatest significance in GDM > 105. The elevations in circulating cholesterol that occur in pregnancy were not significantly different at any time point in NM, GDM < 105, and GDM ^ 105. However, the increases in plasma triglycerides were greater in GDM < 105 and GDM > 105 than in NM and most marked in GDM > 105. Diurnal profiles for a number of individual amino acids (phenylalanine, tyrosine, alanine, serine, proline) were not affected by gestational diabetes. However, certain other amino acids, particularly the branched chain (leucine, isoleucine, valine), tended to be elevated in subjects with GDM and to the most significant extent in GDM > 105. Although the GDM subjects tended to be heavier than the NM, the progressively more pronounced metabolic abnormalities in GDM > 105 than in GDM < 105 would suggest that relative insulinopenia rather than obesity contributed to the differences. Our findings indicate that gestational diabetes is attended by disturbances of varying degrees in all major classes of insulin-dependent foodstuffs and must be viewed as a disorder of multiple fuels, DIABETES CARE 3. -402-409, MAY-JUNE 1980. G estational diabetes mellitus (GDM) is usually ture medium in which the conceptus develops. 1 " 3 In keeping viewed as a minor abnormality in glucose ho-with this formulation it was reasoned that disturbances in meostasis. The present studies represent the first multiple aspects of maternal fuel economy would serve to enefforts to quantify the magnitude of the carbohy-hance the pathophysiologic implications of GDM for the drate abnormalities and to include amino acids, triglycerides, fetus. and cholesterol in the concurrent assessment of other fuels.Our efforts have indicated that even the mildest forms of Blood samples have been secured "around-the-clock" for 24 GDM are attended by demonstrable deviations from normal h in mothers with normal carbohydrate metabolism and in the circulating levels of e...

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Section: Methodsmentioning

confidence: 99%

Effects of Gestational Diabetes on Diurnal Profiles of Plasma Glucose, Lipids, and Individual Amino Acids

et al. 1980

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“…79 Several years ago, we tested this directly. 77 Women with normal carbohydrate metabolism and age-and weightmatched non-gravid controls were given liquid formula 2100 calorie diets in three equal feedings at 8 a.m., 1 p.m., and:6 p.m. Blood was secured "around the clock" from indwelling venous catheters for one 24-h period.…”

Section: Non-gravidmentioning

confidence: 99%

“…Pregnant subjects were studied during weeks 33-39 of gestation. All subjects were maintained on a metabolism ward and receiving 2110 kcal/day of liquid formula diet (275 g carbohydrate, 76 g protein) In three equal feedings as described In text 77. …”

mentioning

confidence: 99%

Banting Lecture 1980: of Pregnancy and Progeny

1980

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A profile characteristic of fuel economy in the mother during normal pregnancy has been delineated. The evidence indicates that pregnancy changes the metabolism of every class of foodstuff. The mechanisms by which the conceptus may be implicated are reviewed. The gestational interactions create a pattern of "accelerated starvation" whenever food is withheld, especially in late pregnancy, and they tend to "facilitate anabolism" when food is ingested. The consequent heightened metabolic oscillations during the shuttlings from fed to fasted state provide a basis for more aggressive therapy with exogenous insulin when endogenous insulin is lacking in pregnancy. It is emphasized that developing fetal structures may be exquisitely attuned to fine alterations in maternal fuel economy and that pregnancy complicated by diabetes may merely exaggerate these normal dependencies since maternal insulin affects all maternal fuels. The manifest changes in the offspring of mothers with even the mildest limitations in insulin reserve, i.e., gestational diabetes, attest to the sensitivity of the relationships. It is suggested that concepts of teratogenesis should be expanded to include alterations occurring subsequent to organogenesis during the differentiation and proliferation of fetal cells. Such changes could cause long-range effects upon behavioral, anthropometric, and metabolic functions. It is hypothesized that all of these could constitute expressions of fuel-mediated teratogenesis and that the potentialities should be incorporated into any evaluation of the outcome of pregnancy in gestations attended by disturbances in maternal fuel metabolism.

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“…Certain amino acids for instance have been shown to be potent stimuli to pancreatic insulin secretion [27] and may be a primary cause of fetal B cell hyperplasia characteristically seen in large infants of diabetic mothers. It has also been shown that small changes of non-esterified fatty acid and ketone levels can have marked effects on placental metabolism and fat deposition in vitro and these changes may be implicated in the in vivo changes in placental structure and function in diabetic mothers [8]. Clinically an association between maternal diabetes complicated by acetonuria and neuropsychological deficits in the children has been suggested to be present in both severe diabetes as well as in mild, including gestational diabetes [28], though other confirmatory studies are required.…”

Section: Discussionmentioning

confidence: 99%

Diurnal variations in blood intermediary metabolites in mild gestational diabetic patients and the effect of a carbohydrate-restricted diet

1982

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Twenty-four hour metabolic profiles were performed in the third trimester of pregnancy in seven non-diabetic women (group A) and in two groups of mild gestational diabetics, at diagnosis (group B, seven patients) and after treatment with a 150-g carbohydrate diet (group C, seven patients). Mean 24-h blood metabolite levels (+/- SD) in groups A, B and C were: glucose: 4.65 +/- 0.82, 5.35 +/- 3.06 and 5.40 +/- 1.7 mmol/l; alanine: 1.05 +/- 0.18, 1.14 +/- 0.42 and 0.78 +/- 0.22 mmol/l; alanine: 0.31 +/- 0.03, 0.31 +/- 0.10 and 0.27 +/-0.07 mmol/l; ketone bodies: 0.11 +/- 0.04, 0.19 +/- 0.05 and 0.26 +/- 0.15 mmol/l. Glucose levels were not significantly different between the groups. Ketone body levels were elevated in the diabetics prior to treatment (p less than 0.01) and rose higher on diet. Lactate levels were reduced on the diet (0.05 less than p less than 0.10). Abnormalities in the concentrations of total blood ketone body levels in gestational diabetics may be detrimental to fetal development and therapy should be designed to minimise changes in intermediary metabolites.

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Intermediary Metabolism During Normal Pregnancy

Cited by 16 publications

References 66 publications

Effects of Gestational Diabetes on Diurnal Profiles of Plasma Glucose, Lipids, and Individual Amino Acids

Effects of Gestational Diabetes on Diurnal Profiles of Plasma Glucose, Lipids, and Individual Amino Acids

Banting Lecture 1980: of Pregnancy and Progeny

Diurnal variations in blood intermediary metabolites in mild gestational diabetic patients and the effect of a carbohydrate-restricted diet

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