Review: Etiology and Pathophysiology of Gestational Diabetes Mellitus

Abstract

In pregnancy, several physiologic changes take place, the sum of which tends to reset the glucose homeostasis in the direction of diabetes. About 1-2% of all pregnant women develop an abnormal glucose tolerance in pregnancy, but most often glucose tolerance returns to normal postpartum. This condition is called gestational diabetes mellitus (GDM). The possibility that glucose tolerance deteriorates in pregnancy because of diabetes-like changes in the secretory function of the endocrine pancreas has been investigated in healthy controls and in normal-weight gestational diabetic subjects. The insulin responses to oral glucose and mixed meals are equally large in these two groups, but the insulin response per unit of glycemic stimulus is significantly lower in the gestational diabetic subjects than in the controls. Diabetes-like changes in glucagon secretion are not observed in either group. Insulin degradation is unaffected by human pregnancy and the proinsulin share of the total plasma insulin immunoreactivity does not increase in pregnancy. Insulin receptor binding to monocytes from normal pregnant women is increased in midpregnancy but is significantly decreased in late pregnancy. No difference in insulin binding (at tracer insulin concentration) to monocytes from healthy pregnant controls and gestational diabetic subjects is found. The insulin concentration necessary to reduce tracer insulin binding by 50% (ID50) is lower in the gestational diabetic subjects diagnosed in late pregnancy than in the pregnant controls. Together, these findings indicate that the number of insulin receptors on monocytes is decreased in GDM at this stage of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Visfatin concentration is decreased in women with gestational diabetes mellitus in the third trimester

“…Therefore, placental visfatin expression should be investigated in GDM. Furthermore, visfatin concentrations might be under the effects of some hormones (including human placental lactogen and progesterone) that circulate in high concentrations during pregnancy (21), although the effect of these hormones on circulating visfatin in GDM is not currently known. On the other hand, it may be speculated that insulin therapy could effect our results since insulin administration was shown to decrease visfatin concentrations (14).…”

2D-DIGE to identify proteins associated with gestational diabetes in omental adipose tissue

“…Alarmingly, it is predicted that w350 million people worldwide will be diagnosed with type 2 diabetes by the year 2030, double the current number (Wild et al 2004). Gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy (Kuhl 1998), affects up to 18% of all pregnancies (Pregnancy 2010). Like type 2 diabetes, the prevalence rate of GDM has also increased dramatically in the last decade (Darios et al 2008, Laws & Sullivan 2009.…”

Treinamento aeróbico e de força no tratamento do diabetes gestacional: uma revisão sistemática

“…18 . Em gestantes saudáveis a secreção de insulina aumenta de duas a quatro vezes, com o objetivo de manter os níveis de glicose normais, o que não ocorre com as gestantes com DMG, visto que elas não conseguem aumentar a produção de insulina de maneira suficiente a compensar sua resistência 26 . O mecanismo pelo qual a gestação induz a resistência à insulina ainda não está claro, entretanto, a maioria das mulheres com DMG parecem apresentar disfunção nas células β-pancreáticas, que ocorre devido a uma resistência crônica à insulina presente antes da gestação 27,28 .…”