Pathophysiological aspects of the development of gestational diabetes
T.Yu. Demidova, F.O. Ushanova
Pirogov Russian National Research Medical University, Moscow
Gestational diabetes is the most common metabolic disorder in pregnancy managed by many healthcare providers. This is accounted for by an increasing number of pregnant women with this condition as well as wide adoption of screening techniques. Recent ongoing fundamental researches will gain a better understanding of the mechanisms of the development of gestational diabetes which is largely similar to type 2 diabetes (in particular, in some pathophysiological aspects and etiological role of major risk factors). In-depth study of pathogenic mechanisms of gestational diabetes will stratify its prognosis and the prognosis of unfavorable perinatal and late metabolic outcomes more accurately and promote the development of effective preventive technologies and management strategies. Pathogenesis of gestational diabetes is diverse and complex. Studies on molecular genetic and epigenetic mechanisms of carbohydra te metabolism disorders during pregnancy will identify women with higher risk of gestational diabetes more effectively, promote the choice of active prevention measures and the development of pathogenic treatment.
Keywords: gestational diabetes, pregnancy, hyperglycemia, insulin resistance, obesity, genetic markers.
For citation: Demidova T.Yu., Ushanova F.O. Pathophysiological aspects of the development of gestational diabetes. RMJ. Medical Review. 2019;10(II):86–91.
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5. Setji T.L., Brown A.J., Feinglos M.N. Gestational Diabetes Mellitus. Clinical Diabetes. 2005;23(1):17–24. DOI./10.2337/diaclin.23.1.17.
6. Bener A., Saleh N.M., Al-Hamaq A. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons. Int J Womens Health. 2011;3:367–373.
7. Петрухин В.А., Бурумкулова Ф.Ф. Гестационный сахарный диабет. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2014;1(1):48–51. [Petrukhin V.A., Burumkulova F.F. Gestation diabetes mellitus. Archive of Obstetrics and Gynecology. V.F. Snegireva. 2014;1(1):48–51 (in Russ.)].
8. Потин В.В., Боровик Н.В., Тиселько А.В. Сахарный диабет и репродуктивная система женщины. Журнал акушерства и женских болезней. 2006;1:85–90. [Poteen V.V., Borovik N.V., Tiselko A.V. Diabetes mellitus and female reproductive system. Journal of Obstetrics and Women’s Diseases. 2006;55(1):85–90 (in Russ.)].
9. Powe C.E., Tobias D.K., Michels K.B. et al. History of gestational diabetes mellitus and risk of incident invasive breast cancer among parous women in the Nurses’ Health Study II prospective cohort. Canc Epidemiol Biomark Prev. 2017;26(3):321–327. DOI: 10.1158/1055-9965.EPI-16-0601.
10. Kiihl С. Insulin secretion and insulin resistance in pregnancy and GDM. Implications for diagnosis and management. Diabetes. 1991;40(2):18–24.
11. Kjos A., Buchanan T. Gestational diabetes mellitus. N Engl J Med. 1999;341:1749–1756.
12. Gauster M., Desoye G., Tötsch M., Hiden U. The placenta and gestational diabetes mellitus. Curr Diab Rep. 2012;12(1):16–23. DOI: 10.1007/s11892-011-0244-5.
13. Ogden C.L., Carroll M.D., Curtin L.R. et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. J Am Med Assoc. 2006;295(13):1549–1555.
14. Robinson H.E., O’Connell C.M., Joseph K.S., McLeod N.L. 35. Maternal outcomes in pregnancies complicated by obesity. Obstet. Gynecol. 2005;106:1357–1364.
15. Crane J.M., White J., Murphy P. et al. The effect of gestational weight gain by body mass index on maternal and neonatal outcomes. J Obstet Gynaecol Canada. JOGC. 2009;31(1):28–35.
16. Mumford S., Knaack J., Thieda P. et al. A systematic review of outcomes of maternal weight gain according to the institute of medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):331–339.
17. Knight M., Kurinczuk J.J., Spark P., Brocklehurst P. Extreme obesity in pregnancy in the United Kingdom. Obstet. Gynecol. 2010;115:989–997.
18. Chu S.Y., Kim S.Y., Schmid C.H. et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes. Rev. J Int Assoc Study Obes. 2007;8(5):385–394.
19. Beard R.W., Regan L., Robinson S. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int. J Obes Rela. Metab Disord. 2001;25(8):1175–1182.
20. Heslehurst N., Simpson H., Ells L.J. et al. The impact of maternal BMI status on pregnancy outcomes with immediate shortterm obstetric resource implications: a meta-analysis. Obes Rev. 2008;9:635–683.
21. Lawlor D.A., Fraser A., Lindsay R.S. et al. Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort. Diabetologia. 2010;53(1):89–97. DOI: 10.1007/s00125-0091560-z.
22. Саприна Т.В., Тимохина Е.С., Мусина Н.Н. и др. Панкреатические и экстрапанкреатические эффекты инкретинов и перспективы изучения энтероинсулярной гормональной системы у беременных женщин при гестационном нарушении углеводного обмена. Бюллетень сибирской медицины. 2013;3:132–147. [Saprina T.V., Timokhina E.S., Musina N.N. et al. Pancreatic and extrapancreatic effects of incretins and prospects for studying the enteroinsular hormonal system in pregnant women with gestational impairment of carbohydrate metabolism. Bulletin of Siberian medicine. 2013;3:132–147 (in Russ.)].
23. Nadkarni P., Chepurny O.G., Holz G.G. Regulation of Glucose Homeostasis by GLP-1. Progress in Molecular Biology and Translational Science. 2014;121:23–65. DOI:10.1016/b978–0-12–800101–1.00002–8.
24. Cypryk K., Vilsboll T., Nadel I. et al. Normal secretion of the incretin hormones glucose-dependent insulinotropic poly-peptide and glucagon-like peptide-1 during gestational diabetes mellitus. Gynecol Endocrinol. 2007;23(1):58–62. DOI:10.1080/09513590601137004.
25. Reyes-Lopez R., Perez-Luque E., Malacara J.M. Metabolic, hormonal characteristics and genetic variants of TCF7L2 associated with development of gestational diabetes mellitus in Mexican women. Diab/Metabol Res Rev. 2014;30(8):701–706. DOI:10.1002/dmrr.2538.
26. Pacini G., Tura A., Winhofer Y., Kautzky-Willer A. Incretin Effect in Women with Former Gestational Diabeteswithin a Short Period after Delivery. Int J Endocrinol. 2012:1–4. DOI:10.1155/2012/247392.
27. Ratner R.E., Christophi C.A., Metzger B.E. et al. Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008;93(12):4774–4779. DOI:10.1210/jc.2008–0772.7.
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